Organization
SHAVER HOLDINGS, INC.
Active
Other names
Shaver Pharmacy & Compounding Center
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL TORI SHAVER (OWNER)
(208) 235-7243
Entity
Organization
Contact information
Practice address
235 S 4TH, POCATELLO, ID 83201
(208) 232-7750
(208) 233-3343
Mailing address
235 S 4TH AVE, POCATELLO, ID 83201-6438
(208) 232-7750
(208) 233-3343
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
DME264
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043372048
—
ID
05
—
807548000
—
ID
Enumeration date
12/15/2006
Last updated
06/24/2010
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