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General NPI Number Information
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NPI Number | 1144717778
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Entity Type | Organization
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Legal Business Name | SHARE OUR SELVES CORPORATION
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1550 SUPERIOR AVE
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City | COSTA MESA
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State | CA
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Zip | 92627-3653
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Country | US
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Telephone | 949-270-2135
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10159
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City | COSTA MESA
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State | CA
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Zip | 92627-0050
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Country | US
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Telephone | 949-270-2135
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTY WARD
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Credential |
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Telephone | 949-536-3927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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