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General NPI Number Information
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NPI Number | 1770864845
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Entity Type | Organization
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Legal Business Name | PHARMACIST AT LARGE, INC.
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 855 6TH ST
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City | LOVELOCK
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State | NV
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Zip | 89419-0661
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Country | US
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Telephone | 775-273-1700
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Fax | 775-273-9013
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Provider Business Mailing Address
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Address Line | 325 11TH STREET #2
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City | LOVELOCK
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State | NV
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Zip | 89419
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Country | US
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Telephone | 775-273-1700
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Fax | 775-273-9013
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Authorized Official
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Title or Position | R.PH., PRESIDENT
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Name | GRANT MOULTON
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Credential |
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Telephone | 775-273-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | IB00779
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License Number State | NV
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