Provider Demographics
NPI:1770864845
Name:PHARMACIST AT LARGE, INC.
Entity Type:Organization
Organization Name:PHARMACIST AT LARGE, INC.
Other - Org Name:LOVELOCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH., PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-273-1700
Mailing Address - Street 1:325 11TH STREET
Mailing Address - Street 2:#2
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419
Mailing Address - Country:US
Mailing Address - Phone:775-273-1700
Mailing Address - Fax:775-273-9013
Practice Address - Street 1:855 6TH ST
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419-0661
Practice Address - Country:US
Practice Address - Phone:775-273-1700
Practice Address - Fax:775-273-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIB00779333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2992700OtherNCPDP PROVIDER IDENTIFICATION NUMBER