=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710535216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPAMONY20 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2019
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 E HART ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82834-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-620-7071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 E HART ST
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82834-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-620-7071
-----------------------------------------------------
Fax | 307-278-0282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARM D/OWNER/PIC
-----------------------------------------------------
Name | CHADWICK BARDWELL SOMMERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-620-7071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------