Organization
POLE MOUNTAIN PHARMACY LLC
Active
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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