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General NPI Number Information
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NPI Number | 1033292446
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Entity Type | Organization
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Legal Business Name | SUPER D DRUG ACQUISITION CO.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 700 W POPLAR AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-2542
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Country | US
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Telephone | 901-853-2222
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Fax | 901-854-6930
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Provider Business Mailing Address
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Address Line | 2100 BROOKWOOD DR
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City | LITTLE ROCK
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State | AR
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Zip | 72202-1734
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF HME OPERATIONS
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Name | MR. GARY M. BOONE
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Credential |
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Telephone | 479-394-6363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 1921
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1921
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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