Healthcare Provider Details

I. General information

NPI: 1639341720
Provider Name (Legal Business Name): SUPER D. DRUGS ACQUISITION CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BROOKWOOD DR
LITTLE ROCK AR
72202-1734
US

IV. Provider business mailing address

2100 BROOKWOOD DR
LITTLE ROCK AR
72202-1734
US

V. Phone/Fax

Practice location:
  • Phone: 501-296-3300
  • Fax: 501-296-3310
Mailing address:
  • Phone: 501-296-3300
  • Fax: 501-296-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID STROUD
Title or Position: VICE PRESIDENT OF PHARMACY SERVICES
Credential:
Phone: 501-296-3300