Healthcare Provider Details

I. General information

NPI: 1710535216
Provider Name (Legal Business Name): SPAMONY20 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HART ST
BUFFALO WY
82834-1705
US

IV. Provider business mailing address

150 E HART ST
BUFFALO WY
82834-1705
US

V. Phone/Fax

Practice location:
  • Phone: 307-620-7071
  • Fax:
Mailing address:
  • Phone: 307-620-7071
  • Fax: 307-278-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHADWICK BARDWELL SOMMERS
Title or Position: PHARM D/OWNER/PIC
Credential:
Phone: 307-620-7071