| NPI | 1467567404 |
|---|---|
| Doing Business As | MOUNTAIN STATES PHARMACY AT BOONES CREEK |
| Entity Type | Organization |
| Authorized Contact | LISA AUSTIN A VP Reimbursement 423-431-1941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TN 4307) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2017-11-17 |