Provider Demographics
NPI:1679660872
Name:SHAR-RICH INC
Entity Type:Organization
Organization Name:SHAR-RICH INC
Other - Org Name:TABLE ROCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENSBY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-433-6020
Mailing Address - Street 1:200 W FLEMING DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3918
Mailing Address - Country:US
Mailing Address - Phone:828-433-6020
Mailing Address - Fax:828-433-1211
Practice Address - Street 1:200 W FLEMING DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3918
Practice Address - Country:US
Practice Address - Phone:828-433-6020
Practice Address - Fax:828-433-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NC052113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3426928OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC7701395Medicaid
NC0125401Medicaid
NC7701395Medicaid