| NPI | 1336228006 |
|---|---|
| Doing Business As | MOUNTAIN LAKE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | HOWARD BOONE President PIC 304-872-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WV SP0552314) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2010-09-10 |