| NPI | 1013422971 |
|---|---|
| Doing Business As | POLE MOUNTAIN PHARMACY |
| Entity Type | Organization |
| Authorized Contact | BRETT KVENILD Manager 307-460-4080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WY R10169) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2019-12-13 |