=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346061900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED SUPERMARKETS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2024
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 UNSER BLVD, S.E.
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-727-8998
-----------------------------------------------------
Fax | 575-727-8999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7830 ORLANDO AVE
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79423-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-791-8113
-----------------------------------------------------
Fax | 806-791-7490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RX AUDIT & COMPLIANCE SPECIALIST
-----------------------------------------------------
Name | SANDRA WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-791-8113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------