Organization
SHAVER HOLDINGS INC
Active
Other names
SHAVER PHARMACY AND COMPOUNDING CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
LORRI SHAVER RPH (OWNER)
(208) 235-7244
Entity
Organization
Contact information
Practice address
235 S 4TH AVE, POCATELLO, ID 83201-6438
(208) 233-3341
(208) 233-3343
Mailing address
235 S 4TH AVE, POCATELLO, ID 83201-6438
(208) 233-3341
(208) 233-3343
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHA-MOP-LIC-16394
MT
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2104RP
ID
3336C0004X
Compounding Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083720494
—
ID
01
—
2021940
PK
—
Enumeration date
08/21/2006
Last updated
03/10/2017
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