Healthcare Provider Details

I. General information

NPI: 1770907776
Provider Name (Legal Business Name): UNITED SUPERMARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3552 S SONCY RD
AMARILLO TX
79119-6672
US

IV. Provider business mailing address

7830 ORLANDO AVENUE
LUBBOCK TX
79423
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-6815
  • Fax: 806-467-6816
Mailing address:
  • Phone: 806-791-8113
  • Fax: 806-791-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number29049
License Number StateTX

VIII. Authorized Official

Name: TIM PURSER
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 806-791-8113