Pole Mountain Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

R10169 Issued in WY

Legal business name

POLE MOUNTAIN PHARMACY LLC

Practice address

319 E Harney St
Laramie, WY 82072-2523

Phone

(307) 460-4080

Fax

(307) 460-4082

NPI assigned

Dec 13, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brett Kvenild, RPHNPI 1659369668

Title

Manager

Phone

(307) 460-4080

Specialties & licenses 2

Addresses

Other names 1

• Pole Mountain Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Tax ID family

Pole Mountain Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pole Mountain Pharmacy LLC

  • Long Term Care Pharmacy
  • Laramie, WY
  • NPI 1700708203
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brett Kvenild, R.PH.

  • Pharmacist
  • Laramie, WY
  • NPI 1659369668
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1013422971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1717",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820731717",
            "telephone_number": "307-460-4080",
            "fax_number": "307-460-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 E HARNEY ST",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820722523",
            "telephone_number": "307-460-4080",
            "fax_number": "307-460-4082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLE MOUNTAIN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "KVENILD",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "307-460-4080",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WY",
            "license": "R10169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pole Mountain Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Megan J Plant, MS
• Katrina J Plassmeyer, NP-C
• Kelly Jo Plessman, FNP, AANPC
• Rebekah Plourde
• Courtney Poinsett
• Pole Mountain Pharmacy LLC
• Theresa J Poll, MS NCC LPC CAJSM
• Tiffany Polson, DPT
• Lauren E Ponwith
• Gabrielle Pool, PCSW

• All providers in Laramie, WY
• Community/Retail Pharmacy in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.