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MOUNTAIN LAKE PHARMACY
NPI 1336228006
Pharmacy - Community/Retail Pharmacy in Summersville, WV

Active since November 03, 2006
1129 BROAD ST, STE 100, SUMMERSVILLE, WV 26651(304) 872-9000(304) 872-4419 Get Directions Write a Review

NPPES record last updated: September 10, 2010. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Mountain Lake Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNTAIN LAKE PHARMACY (NPI 1336228006) is a healthcare organization registered as a community/retail pharmacy in Summersville, West Virginia and active in the NPI registry since November 2006. The organization lists Howard Boone, President Pic, as its authorized official.

NPPES Registry Identity

NPI1336228006
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameMOUNTAIN LAKE PHARMACY INC
Location Address1129 BROAD ST, STE 100Summersville, WV 26651-1838
Mailing Address1129 Broad St, Ste 100Summersville, WV 26651-1838 · (304) 872-9000 · Fax (304) 872-4419
Phone(304) 872-9000
Fax(304) 872-4419
Organization SubpartNo
Authorized OfficialHoward BoonePresident Pic · (304) 872-9000
Enumeration DateNovember 3, 2006
Last NPPES UpdateSeptember 10, 2010
✔ NPI 1336228006 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in WV · SP0552314
Definition
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.
Also ListedPharmacyTaxonomy 333600000X
1129 BROAD ST, Summersville, WV 26651
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Other Names 1

Doing Business AsMountain Lake Pharmacy

Other Identifiers 3

Medicare NSC5452150001
Other5054046Ncpdp Provider Identification Number
Medicaid6001398000WV

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
11 services11 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
11 services11 patients

Medical Equipment Supplier Medicare DMEPOS 5

Medicare supplier enrollment and the product categories Mt Lake Pharmacy Inc carries, from the Medicare DMEPOS supplier directory.

Mt Lake Pharmacy Inc

DMEPOS supplier · Summersville, WVOperated by Mountain Lake Pharmacy Inc
⋮

Does not accept Medicare assignment

Mt Lake Pharmacy Inc has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20581067
Medicare Participant SinceApril 21, 2005
Supplier Location1129 Broad St Ste 100Summersville, WV 26651
Phone(304) 872-9000
Supplier Specialties
Pharmacy

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. HOWARD STEPHEN BOONE R.PH.
Pharmacist
1129 BROAD ST, SUITE 100
SUMMERSVILLE, WV 26651
Nicholas County (304) 872-9000
MR. KRIS E MOOSE RPH
Pharmacist
1129 BROAD ST, SUITE 100
SUMMERSVILLE, WV 26651
Nicholas County (304) 872-9000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mountain Lake Pharmacy Inc's NPI number?

The NPI number for Mountain Lake Pharmacy Inc is 1336228006. It was assigned to this organization in the NPPES registry on November 3, 2006. The provider is doing business as Mountain Lake Pharmacy.

Where is Mountain Lake Pharmacy Inc located?

Mountain Lake Pharmacy Inc is located at 1129 Broad St Ste 100, Summersville, WV 26651. The listed phone number is (304) 872-9000.

What is Mountain Lake Pharmacy Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Mountain Lake Pharmacy Inc accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Mt Lake Pharmacy Inc does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

What insurance does Mountain Lake Pharmacy Inc accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 49 other insurers list Mountain Lake Pharmacy Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mountain Lake Pharmacy Inc was last updated on September 10, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.