NPIMap

Organization Active NPI

Shade Mountain Pharmacy LLC

  • Long Term Care Pharmacy
  • Mt Pleasant Mills, PA
National Provider Identifier
1801793419
Registry record updated Oct 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
SHADE MOUNTAIN PHARMACY LLC
Practice address
9627 Route 35 Ste 20
Mount Pleasant Mills, PA 17853-8409
Phone
(570) 539-2050
Fax
(570) 539-8581
NPI assigned
Oct 26, 2026
Last updated
Oct 26, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SHADE MOUNTAIN PHARMACY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 26, 2026

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

Authorized official

Name
Tyler TruttNPI 1205294147
Title
Owner
Phone
(570) 966-8788

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

9627 Route 35 Ste 20
Mount Pleasant Mills, PA 17853-8409

Mailing address

9627 Route 35 Ste 20
Mount Pleasant Mills, PA 17853-8409
Phone (570) 539-2050

National Provider Directory

National Provider Directory
Tax ID family
Shade 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.

Locations

9627 Route 35
#20
Mt Pleasant Mills, PA 17853
Phone (570) 539-2050

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1792972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792972800000",
    "number": "1801793419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9627 ROUTE 35 STE 20",
            "city": "MOUNT PLEASANT MILLS",
            "state": "PA",
            "postal_code": "178538409",
            "telephone_number": "570-539-2050",
            "fax_number": "570-539-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9627 ROUTE 35 STE 20",
            "city": "MOUNT PLEASANT MILLS",
            "state": "PA",
            "postal_code": "178538409",
            "telephone_number": "570-539-2050",
            "fax_number": "570-539-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADE MOUNTAIN PHARMACY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHADE MOUNTAIN PHARMACY LLC",
        "enumeration_date": "2026-10-26",
        "last_updated": "2026-10-26",
        "certification_date": "2026-10-26",
        "status": "A",
        "authorized_official_last_name": "TRUTT",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-966-8788"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant Mills, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.