Organization
MOUNTAIN LAKE PHARMACY INC
Active
Other names
MOUNTAIN LAKE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD BOONE RPH (PRESIDENT PIC)
(304) 872-9000
Entity
Organization
Contact information
Practice address
1129 BROAD ST, STE 100, SUMMERSVILLE, WV 26651-1838
(304) 872-9000
(304) 872-4419
Mailing address
1129 BROAD ST, STE 100, SUMMERSVILLE, WV 26651-1838
(304) 872-9000
(304) 872-4419
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
SP0552314
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5054046
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6001398000
—
WV
Enumeration date
11/03/2006
Last updated
09/10/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us