Provider Demographics
NPI:1043372048
Name:SHAVER HOLDINGS, INC.
Entity Type:Organization
Organization Name:SHAVER HOLDINGS, INC.
Other - Org Name:SHAVER PHARMACY & COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:TORI
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-235-7243
Mailing Address - Street 1:235 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6438
Mailing Address - Country:US
Mailing Address - Phone:208-232-7750
Mailing Address - Fax:208-233-3343
Practice Address - Street 1:235 S 4TH
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-232-7750
Practice Address - Fax:208-233-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDME264332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807548000Medicaid
ID1043372048Medicaid
ID5748320001Medicare NSC