| NPI | 1881693653 |
|---|---|
| Doing Business As | OVER THE MOUNTAIN COMPOUNDING PHARMACY |
| Entity Type | Organization |
| Authorized Contact | LEA MARIE WOLSONCROFT President 205-824-0775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: AL 112116) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: AL 112116) |
| 3336S0011X Pharmacy, Specialty Pharmacy (Licence: AL 112116) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AL 112116) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2017-03-16 |