Healthcare Provider Details

I. General information

NPI: 1467617852
Provider Name (Legal Business Name): SHAVER LTC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 TURNPIKE DR SUITE 209
WESTMINSTER CO
80031-7041
US

IV. Provider business mailing address

436 E BONNEVILLE ST
POCATELLO ID
83201-6406
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-6554
  • Fax: 303-430-6549
Mailing address:
  • Phone: 208-233-3466
  • Fax: 208-235-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL TORI SHAVER
Title or Position: OWNER
Credential:
Phone: 208-235-7243