Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
BH Specialty Pharmacy-KPT
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3423
Entity
Organization
Contact information
Practice address
2202 N JOHN B DENNIS HWY, KINGSPORT, TN 37660-5904
(423) 434-7443
(423) 302-3537
Mailing address
2 PROFESSIONAL PARK DR STE 15, JOHNSON CITY, TN 37604-6584
(423) 434-7443
(423) 302-3537
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0440176
—
TN
Enumeration date
04/27/2021
Last updated
01/24/2022
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