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General NPI Number Information
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NPI Number | 1316984743
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Entity Type | Organization
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Legal Business Name | UNITED SUPERMARKETS LLC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 1350 E 8TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4714
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Country | US
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Telephone | 432-332-7361
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Fax | 432-332-0393
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Provider Business Mailing Address
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Address Line | 250 E PARKCENTER BLVD
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City | BOISE
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State | ID
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Zip | 83706-3940
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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 | ENROLLMENTS MANAGER
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Name | KATHY GIANNAKOPOULOS
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Credential |
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Telephone | 208-395-3954
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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 | 29387
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License Number State | TX
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