Provider Demographics
NPI:1184976961
Name:WHITE MOUNTAIN PHARMACY INC
Entity type:Organization
Organization Name:WHITE MOUNTAIN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZMESKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-838-2000
Mailing Address - Street 1:21 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:NH
Mailing Address - Zip Code:03585-6600
Mailing Address - Country:US
Mailing Address - Phone:603-838-2000
Mailing Address - Fax:603-838-2000
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:NH
Practice Address - Zip Code:03585-6600
Practice Address - Country:US
Practice Address - Phone:603-838-2000
Practice Address - Fax:603-838-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3061493OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NH30709944Medicaid