MEDICARE: SPAMONY20 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710535216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPAMONY20 LLC

Provider Business Mailing Address
First Line	:	150 E HART ST
Second Line	:
City	:	BUFFALO
State	:	WY
Zip	:	82834-1705
Country	:	US
Telephone Number	:	307-620-7071
Fax Number	:	307-278-0282

Provider Business Practice Location Address
First Line	:	150 E HART ST
Second Line	:
City	:	BUFFALO
State	:	WY
Zip	:	82834-1705
Country	:	US
Telephone Number	:	307-620-7071
Fax Number	:

Authorized Official
Title or Position	:	PHARM D/OWNER/PIC
Name	:	CHADWICK BARDWELL SOMMERS
Credential	:
Telephone Number	:	307-620-7071

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	12/12/2025

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Directions to “SPAMONY20 LLC ” Practice Location

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