Provider Demographics
NPI:1922048768
Name:HIGH MOUNTAIN CORPORATION
Entity Type:Organization
Organization Name:HIGH MOUNTAIN CORPORATION
Other - Org Name:RUTLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:802-775-2545
Mailing Address - Street 1:75 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4501
Mailing Address - Country:US
Mailing Address - Phone:802-775-2545
Mailing Address - Fax:802-773-2489
Practice Address - Street 1:75 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4501
Practice Address - Country:US
Practice Address - Phone:802-775-2545
Practice Address - Fax:802-773-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
VT03800021413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006689Medicaid
2101388OtherPK
1105210001Medicare NSC
VT1105210001Medicare NSC