Provider Demographics
NPI:1780695296
Name:SPRING CREEK PHARMACY LLC
Entity type:Organization
Organization Name:SPRING CREEK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-777-9119
Mailing Address - Street 1:PO BOX 8270
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:568 SPRING VALLEY CT
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-6821
Practice Address - Country:US
Practice Address - Phone:775-777-9119
Practice Address - Fax:775-777-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH00969333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2804908Medicaid
2905339OtherOTHER ID NUMBER-COMMERCIAL NUMBER