Healthcare Provider Details

I. General information

NPI: 1831067610
Provider Name (Legal Business Name): UNITED SUPERMARKETS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N US HWY 385
ANDREWS TX
79714
US

IV. Provider business mailing address

7830 ORLANDO AVE
LUBBOCK TX
79423
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SANDRA WILSON
Title or Position: RX AUDIT & COMPLIANCE SPECIALIST
Credential:
Phone: 806-791-8113