Provider Demographics
NPI:1528026333
Name:IRON MOUNTAIN VAMC
Entity Type:Organization
Organization Name:IRON MOUNTAIN VAMC
Other - Org Name:IRON MOUNTAIN VAMC PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:NPI TEAM
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-382-2579
Mailing Address - Street 1:PO BOX 94484
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-4484
Mailing Address - Country:US
Mailing Address - Phone:608-821-7200
Mailing Address - Fax:608-821-7658
Practice Address - Street 1:325 EAST H. STREET
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4760
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:906-779-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2350192OtherNCPDP#