Provider Demographics
NPI:1720345309
Name:BLUE MOUNTAIN COMPOUNDING LLC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN COMPOUNDING LLC
Other - Org Name:BLUE MOUNTAIN COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-287-6341
Mailing Address - Street 1:2453 PLAZA CT
Mailing Address - Street 2:STE B
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-8762
Mailing Address - Country:US
Mailing Address - Phone:484-287-6341
Mailing Address - Fax:484-287-6340
Practice Address - Street 1:2453 PLAZA CT
Practice Address - Street 2:STE B
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-8762
Practice Address - Country:US
Practice Address - Phone:484-287-6341
Practice Address - Fax:484-287-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4821973336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy