Mountain Lake Pharmacy INC
NPI #1336228006 in Summersville, West Virginia
Provider Information
- NPI Number
- 1336228006
- Entity Type
- Organization
- Organization Name
- Mountain Lake Pharmacy INC
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- Nov 3, 2006
- Last Updated
- Sep 10, 2010
Practice Location
- Address
- 1129 BROAD ST
- Address 2
- STE 100
- City
- Summersville
- State
- West Virginia
- ZIP Code
- 26651-1838
- Phone
- (304) 872-9000
Authorized Official
- Name
- HOWARD BOONE, RPH
- Title
- PRESIDENT PIC
- Phone
- (304) 872-9000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy |
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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