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General NPI Number Information
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NPI Number | 1649296716
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Entity Type | Organization
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Legal Business Name | SUPER DISCOUNT PHARMACY
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2010 SPRING PLACE RD SE
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City | CLEVELAND
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State | TN
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Zip | 37323-3337
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Country | US
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Telephone | 423-472-2121
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Fax | 423-472-2169
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Provider Business Mailing Address
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Address Line | PO BOX 3240
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City | CLEVELAND
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State | TN
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Zip | 37320-3240
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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 | OWNER
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Name | JOE MOORE
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Credential | CPHT
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Telephone | 423-472-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0000000248
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License Number State | TN
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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 |
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License Number State |
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