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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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