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General NPI Number Information
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NPI Number | 1477982650
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Entity Type | Organization
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Legal Business Name | MOUNTAIN COMPREHENSIVE HEALTH CORPORATION
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 99 KY 11 SOUTH
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City | BOONEVILLE
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State | KY
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Zip | 41314
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Country | US
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Telephone | 606-593-6337
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Fax | 606-593-4000
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Provider Business Mailing Address
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Address Line | PO BOX 1143
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City | BOONEVILLE
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State | KY
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Zip | 41314-1143
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Country | US
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Telephone | 859-893-1064
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | DELENA P MILLER
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Credential |
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Telephone | 606-633-4823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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