Provider Demographics
NPI:1760882831
Name:PHARMACIST AT LARGE, INC.
Entity Type:Organization
Organization Name:PHARMACIST AT LARGE, INC.
Other - Org Name:SILVER STAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:775-426-9385
Mailing Address - Street 1:5424 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-4272
Mailing Address - Country:US
Mailing Address - Phone:775-909-4855
Mailing Address - Fax:775-909-4851
Practice Address - Street 1:1250 NEVADA AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SILVER SPRINGS
Practice Address - State:NV
Practice Address - Zip Code:89429
Practice Address - Country:US
Practice Address - Phone:775-909-4855
Practice Address - Fax:775-909-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy