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General NPI Number Information
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NPI Number | 1770582009
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Entity Type | Organization
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Legal Business Name | SUPER D DRUGS ACQUISTION CO.
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 367 N GLOSTER ST
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City | TUPELO
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State | MS
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Zip | 38804-3633
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Country | US
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Telephone | 662-844-4530
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Fax | 662-844-9927
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Provider Business Mailing Address
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Address Line | 367 N GLOSTER ST
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City | TUPELO
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State | MS
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Zip | 38804-3633
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Country | US
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Telephone | 662-844-4530
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Fax | 662-844-9927
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Authorized Official
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Title or Position | VP PHARMACY SERVICES
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Name | DAVID STROUD
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Credential | RPH
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Telephone | 501-296-3311
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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 | 04930/11.1
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License Number State | MS
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