Provider Demographics
NPI:1659143212
Name:MOUNT GAY PHARMACY INC
Entity Type:Organization
Organization Name:MOUNT GAY PHARMACY INC
Other - Org Name:MOUNT GAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-688-8952
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:MOUNT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25637-0307
Mailing Address - Country:US
Mailing Address - Phone:304-896-0015
Mailing Address - Fax:
Practice Address - Street 1:360 MOUNT GAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT GAY
Practice Address - State:WV
Practice Address - Zip Code:25637
Practice Address - Country:US
Practice Address - Phone:304-896-0015
Practice Address - Fax:304-896-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies