Healthcare Provider Details

I. General information

NPI: 1619084829
Provider Name (Legal Business Name): NUTRISHARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 KENT ST
ELK GROVE CA
95624-9483
US

IV. Provider business mailing address

9850 KENT ST
ELK GROVE CA
95624-9483
US

V. Phone/Fax

Practice location:
  • Phone: 916-685-5034
  • Fax:
Mailing address:
  • Phone: 916-685-5034
  • Fax:

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 NumberPHA442630
License Number StateCA

VIII. Authorized Official

Name: AUSTIN PULSIPHER
Title or Position: PRESIDENT
Credential:
Phone: 916-478-7811