NPI 1013422971 · live from the CMS NPI Registry
Pole Mountain Pharmacy LLC
Pharmacy, Community/Retail Pharmacy in Laramie, WY. National Provider Identifier 1013422971, active.
NPI record
| NPI | 1013422971 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy, Community/Retail Pharmacy 3336C0003X |
| Practice location | 319 E Harney St, Laramie, WY 82072 |
| Practice phone | 307-460-4080 |
| Mailing address | Po Box 1717, Laramie, WY 82073 |
| Enumerated | December 13, 2017 |
| Last updated | December 13, 2019 |
| Authorized official | Brett Kvenild, Manager |
| Other names | Pole Mountain Pharmacy |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | — |
| Pharmacy, Community/Retail Pharmacy primary | 3336C0003X | R10169 (WY) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.