Organization
MOUNTAINEER MEDICAL PHARMACY LLC
Active
Other names
MOUNTAINEER MEDICAL PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL KOVACK (PHARM MGR)
(304) 423-5000
Entity
Organization
Contact information
Practice address
120 MEDICAL PARK DR STE 102, BRIDGEPORT, WV 26330-9013
(304) 423-5200
(304) 848-6050
Mailing address
120 MEDICAL PARK DR STE 102, BRIDGEPORT, WV 26330-9013
(304) 423-5200
(304) 848-6050
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
SP0552456
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141915
PK
—
Enumeration date
06/28/2013
Last updated
10/26/2013
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