Provider Demographics
NPI:1073326161
Name:MOUNTAIN SPECIALTY PHARMACY LLC
Entity type:Organization
Organization Name:MOUNTAIN SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRITIBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-299-2965
Mailing Address - Street 1:1183 S HAIRSTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2796
Mailing Address - Country:US
Mailing Address - Phone:770-299-2965
Mailing Address - Fax:770-299-2966
Practice Address - Street 1:1183 S HAIRSTON RD STE C
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2796
Practice Address - Country:US
Practice Address - Phone:770-299-2965
Practice Address - Fax:770-299-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy