Provider Demographics
NPI:1235156027
Name:NUPHARM, INC
Entity Type:Organization
Organization Name:NUPHARM, INC
Other - Org Name:HOME CARE SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALTRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-837-2330
Mailing Address - Street 1:PO BOX 121092
Mailing Address - Street 2:DEPT 1092
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:409-951-6437
Mailing Address - Fax:409-654-2068
Practice Address - Street 1:3255 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-1051
Practice Address - Country:US
Practice Address - Phone:409-724-0099
Practice Address - Fax:409-724-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-03-19
Deactivation Date:2009-01-15
Deactivation Code:
Reactivation Date:2009-03-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14357OtherTEXAS VENDOR DRUG
TX1128126-01Medicaid
VA008515191Medicaid
TX0138950-01Medicaid
0376210001Medicare NSC