Organization
SHADE MOUNTAIN PHARMACY LLC
Active
Organization
SHADE MOUNTAIN PHARMACY LLC
Active
Other names
Shade Mountain Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER TRUTT (OWNER)
(570) 539-2050
Entity
Organization
Contact information
Practice address
9627 ROUTE 35 STE 20, MT PLEASANT MILLS, PA 17853-8409
(570) 539-2050
(570) 539-8581
Mailing address
9627 ROUTE 35, SUITE 20, MT PLEASANT MILLS, PA 17853-8409
(570) 539-2050
(570) 539-8581
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP413814L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001047164001
—
PA
01
—
3951399
NABP #
PA
Enumeration date
12/11/2006
Last updated
05/01/2018
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