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General NPI Number Information
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NPI Number | 1528141736
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Entity Type | Organization
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Legal Business Name | SUPER D DISCOUNT DRUGS
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 855 WAYNE RD SUITE A-2
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City | SAVANNAH
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State | TN
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Zip | 38372-1527
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Country | US
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Telephone | 731-925-4932
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Fax | 731-926-2240
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Provider Business Mailing Address
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Address Line | 855 WAYNE RD SUITE A-2
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City | SAVANNAH
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State | TN
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Zip | 38372-1527
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Country | US
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Telephone | 731-925-4932
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Fax | 731-926-2240
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. ROBERT EUGENE SHUTT
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Credential | D.PH.
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Telephone | 731-925-4932
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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 | 1428
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License Number State | TN
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