Provider Demographics
NPI:1790790327
Name:SHARE N CARE PHARMACY AND MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:SHARE N CARE PHARMACY AND MEDICAL SUPPLY LLC
Other - Org Name:SHARE 'N CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-864-7491
Mailing Address - Street 1:701 DALIES AVE
Mailing Address - Street 2:STE B
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002
Mailing Address - Country:US
Mailing Address - Phone:505-864-7471
Mailing Address - Fax:505-864-6535
Practice Address - Street 1:701 DALIES AVE
Practice Address - Street 2:STE B
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3617
Practice Address - Country:US
Practice Address - Phone:505-864-7471
Practice Address - Fax:505-864-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336C0004X
NMPH000024093336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2058611OtherPK
NMN7811Medicaid