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NPI Code Detail

MEDICARE: UNITED SUPERMARKETS LLC

MEDICARE: UNITED SUPERMARKETS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyPH00004382NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22059019OTHERPK

General Provider Information

NPI Number : 1073711404
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED SUPERMARKETS LLC
Provider Business Mailing Address
First Line : 7830 ORLANDO AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79423-1942
Country : US
Telephone Number : 208-395-6200
Fax Number : 806-791-7490
Provider Business Practice Location Address
First Line : 7800 ENCHANTED HILLS BLVD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-8623
Country : US
Telephone Number : 505-771-8411
Fax Number : 505-771-9255
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : TIM PURSER
Credential : CPHT
Telephone Number : 806-791-7410
Provider Enumeration Date : 07/06/2007
Last Update Date : 07/19/2018

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Directions to “UNITED SUPERMARKETS LLC ” Practice Location

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