Healthcare Provider Details

I. General information

NPI: 1003796889
Provider Name (Legal Business Name): NUTRISHARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 E COTTON CENTER BLVD STE 110
PHOENIX AZ
85040-8857
US

IV. Provider business mailing address

4310 E COTTON CENTER BLVD STE 110
PHOENIX AZ
85040-8857
US

V. Phone/Fax

Practice location:
  • Phone: 866-955-5807
  • Fax: 888-626-3344
Mailing address:
  • Phone: 866-955-5807
  • Fax: 888-626-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN PULSIPHER
Title or Position: CFO / TREASURER
Credential:
Phone: 916-478-7811