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Organization

PHARMACIST AT LARGE, INC.

Active
Other names
Lovelock Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
GRANT MOULTON (R.PH., PRESIDENT)
(775) 273-1700
Entity
Organization

Contact information

Practice address
855 6TH ST, LOVELOCK, NV 89419-0661
(775) 273-1700
(775) 273-9013
Mailing address
325 11TH STREET, #2, LOVELOCK, NV 89419
(775) 273-1700
(775) 273-9013

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
IB00779
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2992700
NCPDP PROVIDER IDENTIFICATION NUMBER
Enumeration date
09/02/2011
Last updated
09/02/2011
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