Mesa Ridge, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MESA RIDGE, LLC

Doing business as

Mesa Ridge Pharmacy

Practice address

340 Falcon Ridge Pkwy Ste 403
Mesquite, NV 89027-8851

Phone

(725) 253-0103

Fax

(725) 253-0104

NPI assigned

Aug 8, 2023

Last updated

Dec 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel Wilde, PHARMDNPI 1346929320

Title

Owner/Manager

Phone

(435) 668-8867

Specialties & licenses 1

Addresses

Other names 1

• Mesa Ridge Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Tax ID family

Mesa Ridge LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mesa Ridge, LLC

  dba Mesa Ridge Pharmacy

  • Long Term Care Pharmacy
  • Mesquite, NV
  • NPI 1497567143
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel Michael Wilde, PHARMD

  • Pharmacist
  • Mesquite, NV
  • NPI 1346929320
  NPD Authorized official

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

{
    "created_epoch": "1691452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1750064622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 FALCON RIDGE PKWY STE 403",
            "city": "MESQUITE",
            "state": "NV",
            "postal_code": "890278851",
            "telephone_number": "725-253-0103",
            "fax_number": "725-253-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 FALCON RIDGE PKWY STE 403",
            "city": "MESQUITE",
            "state": "NV",
            "postal_code": "890278851",
            "telephone_number": "725-253-0103",
            "fax_number": "725-253-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA RIDGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-08",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "435-668-8867",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesa Ridge Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mesa Ridge Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Anne Melle
• Kyle D. Memmott, MPT
• Jeromy Ron Mendenhall, PA
• Mercy Air Service, Inc.
• Mesa Ridge, LLC (Mesa Ridge Pharmacy)
• Mesa View Home Care
• Mesa View Home Care, LLC
• Mesa View Hospice, LLC
• Mesa View Physical Rehabilitation, LLC
• Mesa View Regional Hospital

• Community/Retail Pharmacy in Mesquite, NV
• Providers in Mesquite, 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 Dec 6, 2023; 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.