Organization
POLE MOUNTAIN PHARMACY LLC
Active
Other names
Pole Mountain Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT KVENILD RPH (MANAGER)
(307) 460-4080
Entity
Organization
Contact information
Practice address
319 E HARNEY ST, LARAMIE, WY 82072-2523
(307) 460-4080
(307) 460-4082
Mailing address
PO BOX 1717, LARAMIE, WY 82073-1717
(307) 460-4080
(307) 460-4082
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10169
WY
Other
Enumeration date
12/13/2017
Last updated
12/13/2019
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