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NPI Code Detail

MEDICARE: SUPER D DRUGS ACQUISITION CO.

MEDICARE: SUPER D DRUGS ACQUISITION CO.
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
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

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

General Provider Information

NPI Number : 1609857226
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPER D DRUGS ACQUISITION CO.
Provider Business Mailing Address
First Line : 803 HIGHWAY 71 N
Second Line :
City : MENA
State : AR
Zip : 71953-4367
Country : US
Telephone Number : 479-394-6363
Fax Number : 479-394-1046
Provider Business Practice Location Address
First Line : 212 W MAIN ST
Second Line :
City : MALDEN
State : MO
Zip : 63863-2114
Country : US
Telephone Number : 573-276-2218
Fax Number : 573-276-4785
Authorized Official
Title or Position : DIRECTOR HME OPERATIONS
Name : GARY BOONE
Credential :
Telephone Number : 479-394-6363
Provider Enumeration Date : 11/10/2005
Last Update Date : 02/26/2010

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Directions to “SUPER D DRUGS ACQUISITION CO. ” Practice Location

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