Provider Demographics
NPI:1124130125
Name:FRONTIER PHARMACIES LLC
Entity type:Organization
Organization Name:FRONTIER PHARMACIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-423-5491
Mailing Address - Street 1:PO BOX 5160
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89407-5160
Mailing Address - Country:US
Mailing Address - Phone:775-423-5491
Mailing Address - Fax:775-423-8770
Practice Address - Street 1:1870 W WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2648
Practice Address - Country:US
Practice Address - Phone:775-423-3194
Practice Address - Fax:775-423-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NVPH00557333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157666OtherPK
NV002801800Medicaid
2902725OtherOTHER ID NUMBER-COMMERCIAL NUMBER
FT2873835OtherDEA NUMBER