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General NPI Number Information
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NPI Number | 1235212648
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Entity Type | Organization
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Legal Business Name | SUPER D DRUGS ACQUISITION CO
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3050 S NATIONAL AVE STE 109
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City | SPRINGFIELD
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State | MO
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Zip | 65804-4242
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Country | US
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Telephone | 417-887-0572
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Fax | 417-887-0572
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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 | RETAIL SUPPORT
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Name | JOYCE STROM
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Credential |
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Telephone | 501-296-3312
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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 | 6314
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License Number State | MO
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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