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General NPI Number Information
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NPI Number | 1760494033
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Entity Type | Organization
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Legal Business Name | PHARMERICA MOUNTAIN LLC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 2950 E MAGIC VIEW DR STE 190
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-887-1951
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Fax | 208-895-9825
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Provider Business Mailing Address
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Address Line | 805 N WHITTINGTON PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-7101
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Country | US
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Telephone | 502-627-7000
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Fax | 502-627-7401
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. ALLISON L. BROWN
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Credential |
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Telephone | 502-630-7429
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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 | 1929LS
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License Number State | ID
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