MEDICARE: UNITED SUPERMARKETS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH00004372	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2058612	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588603963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED SUPERMARKETS LLC

Provider Business Mailing Address
First Line	:	7830 ORLANDO AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-1942
Country	:	US
Telephone Number	:	208-395-6200
Fax Number	:	806-791-7490

Provider Business Practice Location Address
First Line	:	1625 RIO BRAVO BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-6057
Country	:	US
Telephone Number	:	505-877-2240
Fax Number	:	505-877-1914

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	TIM PURSER
Credential	:	CPHT
Telephone Number	:	806-791-7410

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/19/2018

Similar Medicare Providers

1215525902 — AUGUST VOJDANI PA-C
Practice Location Address:

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841

1487506747 — MARIA CARDONA PATINO
Practice Location Address:

1625 RIO BRAVO BLVD SW
ALBUQUERQUE, NM
87105-6057

Practice Phone: 505-226-0153
Practice Fax:

1154517290 — MRS. JENNIFER SWISHER PHARMD
Practice Location Address:

1625 RIO BRAVO BLVD SW
ALBUQUERQUE, NM
87105-6057

Practice Phone: 505-877-3130
Practice Fax: 505-877-8072

1467685685 — DR. ISHIAH L MAREZ PHARM. D.
Practice Location Address:

1625 RIO BRAVO BLVD SW
ALBUQUERQUE, NM
87105-6057

Practice Phone: 505-877-3130
Practice Fax: 505-877-8072

1780917971 — MIRIAM LUCERO PHARMD
Practice Location Address:

1625 RIO BRAVO BLVD SW , SUITE 36
ALBUQUERQUE, NM
87105-6057

Practice Phone: 505-877-3130
Practice Fax: 505-877-8072

1043590870 — HENRY A LOVATO II BSPH
Practice Location Address:

1625 RIO BRAVO BLVD SW
ALBUQUERQUE, NM
87105-6057

Practice Phone: 505-877-2240
Practice Fax: 505-877-1914

Directions to “UNITED SUPERMARKETS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.