Bountiful Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH03467 Issued in NV

Legal business name

BOUNTIFUL PHARMACY LLC

Doing business as

Silver Stage Pharmacy

Practice address

1250 Nevada Ave # 2
Silver Springs, NV 89429-7979

Phone

(775) 909-4855

NPI assigned

Jun 11, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Christensen, PHARM.D.

Title

Managing Member

Phone

(775) 463-2345

Specialties & licenses 1

Addresses

Other names 1

• Silver Stage Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Bountiful Pharmacy LLC

  • Community/Retail Pharmacy
  • Lovelock, NV
  • NPI 1518450857

  O20220902002167

  Same enrollment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605139200000",
    "number": "1265925606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 823",
            "city": "YERINGTON",
            "state": "NV",
            "postal_code": "894470823",
            "telephone_number": "775-463-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 NEVADA AVE # 2",
            "city": "SILVER SPRINGS",
            "state": "NV",
            "postal_code": "894297979",
            "telephone_number": "775-909-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNTIFUL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-11",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "775-463-2345",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NV",
            "license": "PH03467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silver Stage Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Troy Baltes
• Richard Bargen, M.D.
• Heather Benson
• Yin Bitowft
• Alois Louise Boswell
• Cheryl Bowles, LCSW
• Randy Gerald Cerny
• Ashley Cervantes
• Christina Cervi
• Ronan Cichelli

• Community/Retail Pharmacy in Silver Springs, NV
• Providers in Silver Springs, NV by specialty
• Community/Retail Pharmacy in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.