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General NPI Number Information
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NPI Number | 1255489258
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Entity Type | Organization
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Legal Business Name | SUPERMARKET INVESTORS INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 7507 CANTRELL RD
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City | LITTLE ROCK
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State | AR
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Zip | 72207-2529
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Country | US
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Telephone | 501-296-9376
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Fax | 501-296-9378
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Provider Business Mailing Address
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Address Line | 7507 CANTRELL RD
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City | LITTLE ROCK
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State | AR
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Zip | 72207-2529
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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 PHARMACY
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Name | BRENDA MCCRADY
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Credential | BS PHARMACY
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Telephone | 501-570-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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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 | AR20549
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License Number State | AR
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