Mountain Lake Pharmacy Inc
Community/Retail Pharmacy
1129 Broad St, Ste 100, Summersville
West Virginia, 26651-1838
304-872-9000 304-872-4419
Mountain Lake Pharmacy Inc is a Community/Retail Pharmacy in Summersville, West Virginia. It is located at 1129 Broad St, Ste 100, Summersville and it's customer support contact number is 304-872-9000. The authorized person of Mountain Lake Pharmacy Inc is Howard Boone, RPH who is President Pic of the pharmacy and his contact number is 304-872-9000. Active license number of Mountain Lake Pharmacy Inc is SP0552314 for Community/Retail Pharmacy in West Virginia. Mountain Lake Pharmacy Inc accepts medicare which means medicare covered patients will not be billed for any more than the Medicare deductible and coinsurance.
Mountain Lake Pharmacy Inc is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Pharmacy Details:
Mountain Lake Pharmacy Inc type, location, contact phone number and fax are as below. Patients can directly walkin to the pharmacy or can call on the below given customer support phone number for enquiries.
| Name: | Mountain Lake Pharmacy Inc |
| Type: | Community/Retail Pharmacy |
| Location: | 1129 Broad St, Ste 100, Summersville,
West Virginia, 26651-1838 |
| Phone: | 304-872-9000 |
| Fax: | 304-872-4419 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this pharmacy is as below. Person's position and contact details are also mentioned below.
| Name: | Howard Boone |
| Credentials: | RPH |
| Position: | President Pic |
| Contact Number: | 304-872-9000 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given pharmacy are as mentioned below.
| NPI Number: | 1336228006 |
| NPI Enumeration Date: | 03 Nov, 2006 |
| NPI Last Update On: | 10 Sep, 2010 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mountain Lake Pharmacy Inc are as mentioned below.
| Specialization | License Number | State | Status | |
| Community/Retail Pharmacy | SP0552314 | West Virginia | Primary | |
| Pharmacy | | | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the pharmacy such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 6001398000 | Medicaid | West Virginia | |
| 5054046 | Other | | Ncpdp Provider Identification Number |
Medicare Enrollment:
Mountain Lake Pharmacy Inc is enrolled in medicare and it's Pac Id, enrollment Id, registered name and type is as stated below.
| PAC ID: |
Enrollment ID: |
Org Name | Medicare Entity Type |
| 0345451084 | O20100930034155 | Mountain Lake Pharmacy Inc | DME SUPPLIER - PHARMACY |
Products Available:
Mountain Lake Pharmacy Inc has following products available for sale under medicare.
| Products: |
|---|
| • Blood Glucose Monitors & Supplies: Non-mail Order | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 1129 Broad St, Ste 100
Summersville, West Virginia |
| Zip: | 26651-1838 |
| Phone Number: | 304-872-9000 |
| Fax Number: | 304-872-4419 |
Patients can reach Mountain Lake Pharmacy Inc at
1129 Broad St, Ste 100, Summersville, West Virginia or can
call on customer care at 304-872-9000.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.