MEDICARE: SPRING CREEK PHARMACY 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	333600000X	Pharmacy	PH00969	NV
2	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
2	2905339	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1780695296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING CREEK PHARMACY LLC

Provider Business Mailing Address
First Line	:	PO BOX 8270
Second Line	:
City	:	SPRING CREEK
State	:	NV
Zip	:	89815-0005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	568 SPRING VALLEY CT
Second Line	:
City	:	SPRING CREEK
State	:	NV
Zip	:	89815-6821
Country	:	US
Telephone Number	:	775-777-9119
Fax Number	:	775-777-3342

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA ATKINS
Credential	:
Telephone Number	:	775-777-9119

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/11/2025

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