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General NPI Number Information
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NPI Number | 1871608166
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Entity Type | Organization
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Legal Business Name | SUPER PHARMACY LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1019 H ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-3743
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Country | US
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Telephone | 202-388-0050
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Fax | 202-388-0047
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Provider Business Mailing Address
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Address Line | 1019 H ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-3743
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Country | US
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Telephone | 202-388-0050
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Fax | 202-388-0047
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. ENOCK K ADEWUYI
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Credential | PHD
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Telephone | 202-388-0050
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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 | RX9500254
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License Number State | DC
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