Provider Demographics
NPI:1326699703
Name:MOUNTAINEER DRUG INC.
Entity Type:Organization
Organization Name:MOUNTAINEER DRUG INC.
Other - Org Name:MOUNTAINEER DRUG INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:NICOLE
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:
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 1:9709 MACCORKLE AVE SE, STE A
Practice Address - Street 2:
Practice Address - City:MARMET
Practice Address - State:WV
Practice Address - Zip Code:25315
Practice Address - Country:US
Practice Address - Phone:304-767-1803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAINEER DRUG INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy