Mountain Lake Pharmacy Inc is an authorized DME supplier for medicare equipments and products.
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.
Comments/ Reviews:
*Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 13 October, 2025.
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