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General NPI Number Information
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NPI Number | 1407041817
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Entity Type | Organization
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Legal Business Name | SUPER DISCOUNT PHARMACY LLC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 1423 S COLLINS ST
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City | PLANT CITY
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State | FL
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Zip | 33563-6577
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Country | US
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Telephone | 813-752-1133
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Fax | 813-752-8866
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Provider Business Mailing Address
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Address Line | 1423 S COLLINS ST
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City | PLANT CITY
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State | FL
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Zip | 33563-6577
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Country | US
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Telephone | 813-752-1133
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Fax | 813-752-8866
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Authorized Official
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Title or Position | MANAGER
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Name | MANJIT MATHARU
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Credential |
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Telephone | 813-752-1133
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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 | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH22877
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License Number State | FL
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