Provider Demographics
NPI:1467617852
Name:SHAVER LTC PHARMACY INC
Entity Type:Organization
Organization Name:SHAVER LTC PHARMACY INC
Other - Org Name:HOME LIVING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
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 1:436 E BONNEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6406
Mailing Address - Country:US
Mailing Address - Phone:208-233-3466
Mailing Address - Fax:208-235-7296
Practice Address - Street 1:8501 TURNPIKE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7041
Practice Address - Country:US
Practice Address - Phone:303-430-6554
Practice Address - Fax:303-430-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies