Provider Demographics
NPI:1497397681
Name:MOUNTAIN MEDICINE PHARMACY INC
Entity Type:Organization
Organization Name:MOUNTAIN MEDICINE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:606-637-9011
Mailing Address - Street 1:8857 META HWY
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-4776
Mailing Address - Country:US
Mailing Address - Phone:606-637-9011
Mailing Address - Fax:606-637-9013
Practice Address - Street 1:8857 META HWY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-4776
Practice Address - Country:US
Practice Address - Phone:606-637-9011
Practice Address - Fax:606-637-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy