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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