Provider Demographics
NPI:1407885668
Name:HIGH MOUNTAIN CORPORATION, INC
Entity Type:Organization
Organization Name:HIGH MOUNTAIN CORPORATION, INC
Other - Org Name:LEBANON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-775-2545
Mailing Address - Street 1:20 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1328
Mailing Address - Country:US
Mailing Address - Phone:603-448-1778
Mailing Address - Fax:
Practice Address - Street 1:20 HANOVER ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1328
Practice Address - Country:US
Practice Address - Phone:603-448-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1001971Medicaid
NH3004114OtherNABP
NH1001971Medicaid