| NPI | 1841647179 |
|---|---|
| Doing Business As | MOUNTAIN RANGE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | KENNETH ALLEN BRESSERS Sole Member 920-685-5041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: UT 9777440-1704) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-08-06 |