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General NPI Number Information
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NPI Number | 1558409482
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Entity Type | Organization
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Legal Business Name | UNITED SUPERMARKETS, L.L.C.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 2522 IOWA PARK RD
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City | WICHITA FALLS
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State | TX
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Zip | 76306
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Country | US
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Telephone | 940-322-1114
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Fax | 940-767-3908
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Provider Business Mailing Address
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Address Line | 7830 ORLANDO AVE
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City | LUBBOCK
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State | TX
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Zip | 79423-1942
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Country | US
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Telephone | 806-791-0220
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PHARMACY
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Name | TIM PURSER
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Credential | RPH
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Telephone | 806-791-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 21392
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License Number State | TX
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