Provider Demographics
NPI:1639877319
Name:COLD MOUNTAIN PHARMACY SERVICES
Entity Type:Organization
Organization Name:COLD MOUNTAIN PHARMACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-669-9970
Mailing Address - Street 1:3130 US 70 HWY
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-9108
Mailing Address - Country:US
Mailing Address - Phone:828-669-9970
Mailing Address - Fax:828-669-9980
Practice Address - Street 1:3130 US 70 HWY
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-9108
Practice Address - Country:US
Practice Address - Phone:828-669-9970
Practice Address - Fax:828-669-9980
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLD MOUNTAIN PHARMACY SERVICES L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487292967Medicaid