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General NPI Number Information
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NPI Number | 1497397681
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MEDICINE PHARMACY INC
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 8857 META HWY
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City | PIKEVILLE
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State | KY
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Zip | 41501-4776
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Country | US
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Telephone | 606-637-9011
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Fax | 606-637-9013
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Provider Business Mailing Address
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Address Line | 8857 META HWY
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City | PIKEVILLE
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State | KY
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Zip | 41501-4776
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Country | US
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Telephone | 606-637-9011
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Fax | 606-637-9013
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS PARKER
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Credential | BS
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Telephone | 606-637-9011
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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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