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General NPI Number Information
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NPI Number | 1700708203
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Entity Type | Organization
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Legal Business Name | POLE MOUNTAIN PHARMACY LLC
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 319 E HARNEY ST
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City | LARAMIE
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State | WY
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Zip | 82072-2523
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Country | US
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Telephone | 307-460-4080
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Fax | 307-460-4082
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Provider Business Mailing Address
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Address Line | 319 E HARNEY ST
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City | LARAMIE
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State | WY
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Zip | 82072-2523
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Country | US
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Telephone | 307-460-4080
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Fax | 307-460-4082
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Authorized Official
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Title or Position | MEMBER
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Name | BRETT KVENILD
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Credential | RPH
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Telephone | 307-460-4080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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