Provider Demographics
NPI:1609908284
Name:NUTRISHARE, LLC
Entity Type:Organization
Organization Name:NUTRISHARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PULSIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-478-7811
Mailing Address - Street 1:9850 KENT ST
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9483
Mailing Address - Country:US
Mailing Address - Phone:916-685-5034
Mailing Address - Fax:916-478-7924
Practice Address - Street 1:11020 PLANTSIDE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6105
Practice Address - Country:US
Practice Address - Phone:502-297-0222
Practice Address - Fax:916-478-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06292332BP3500X
KY3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831393OtherNCPDP
KYP08194OtherPHARMACY
KYP08194OtherPHARMACY