Provider Demographics
NPI:1114361805
Name:MOUNTAINEER DRUG INC.
Entity Type:Organization
Organization Name:MOUNTAINEER DRUG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMARR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:304-767-1803
Mailing Address - Street 1:4021 RIDGEVIEW LN
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-1366
Mailing Address - Country:US
Mailing Address - Phone:304-767-1803
Mailing Address - Fax:
Practice Address - Street 1:76 LEWIS STREET
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25209
Practice Address - Country:US
Practice Address - Phone:304-854-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05524503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy