Provider Demographics
NPI:1619084829
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:
Practice Address - Street 1:9850 KENT ST
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9483
Practice Address - Country:US
Practice Address - Phone:916-685-5034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
CAPHA4426303336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA442630Medicaid
CALSC101704OtherPHARMACY (STERILE)
0534126OtherNCPDP
CAPHY58256OtherPHARMACY