Provider Demographics
NPI:1154466274
Name:SHARE N CARE PHARMACY AND MEDICAL
Entity type:Organization
Organization Name:SHARE N CARE PHARMACY AND MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:505-864-7471
Mailing Address - Street 1:701 DALIES AVE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3617
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:
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:2007-02-20
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48021857Medicaid
NM4411640001Medicare NSC