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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
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPH00004423NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22057080OTHERPK

General Provider Information

NPI Number : 1255371621
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNITED SUPERMARKETS LLC
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line :
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11825 LOMAS BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87112-5613
Country : US
Telephone Number : 505-293-9156
Fax Number : 505-323-1740
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 06/07/2006
Last Update Date : 05/11/2026

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Directions to “UNITED SUPERMARKETS LLC ” Practice Location

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