=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750555447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPERMARKET INVESTORS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2008
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8109 INTERSTATE 30
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72209-4840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-570-0007
-----------------------------------------------------
Fax | 501-565-3975
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8109 INTERSTATE 30
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72209-4840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-570-0007
-----------------------------------------------------
Fax | 501-565-3975
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | BRENDA MCCRADY
-----------------------------------------------------
Credential | P.D.
-----------------------------------------------------
Telephone | 501-570-0007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------