Shade Mountain Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP413814L Issued in PA

Legal business name

SHADE MOUNTAIN PHARMACY LLC

Doing business as

Shade Mountain Pharmacy

Practice address

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

Phone

(570) 539-2050

Fax

(570) 539-8581

NPI assigned

Dec 11, 2006

Last updated

May 1, 2018By the provider in NPPES

Organization subpart

No

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) 539-2050

Specialties & licenses 1

Addresses

Other names 1

• Shade Mountain Pharmacy Doing business as

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Shade Mountain Pharmacy LLC

  • Long Term Care Pharmacy
  • Mt Pleasant Mills, PA
  • NPI 1801793419
  NPPES parent name

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.

• Tyler Trutt

  • Pharmacist
  • Mt Pleasant Mills, PA
  • NPI 1205294147
  NPD Authorized official

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525132800000",
    "number": "1912067778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9627 ROUTE 35",
            "address_2": "SUITE 20",
            "city": "MT 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": "MT 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": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2018-05-01",
        "status": "A",
        "authorized_official_last_name": "TRUTT",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-539-2050"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP413814L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shade Mountain Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shade Mountain Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erica Rhoads, MS, LPC
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• Jason William Schlothauer, EMSVO
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• Timothy Earl Slavens, MD
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• Tyler Trutt
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• David M Watto, D.C

• Community/Retail Pharmacy in Mt Pleasant Mills, PA
• Providers in Mt Pleasant Mills, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2018; 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.