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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PH00004425	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2059018	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306044730
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	:	2910 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1828
Country	:	US
Telephone Number	:	505-299-8600
Fax Number	:	505-299-8609

Authorized Official
Title or Position	:	ENROLLMENTS MANAGER
Name	:	KATHY GIANNAKOPOULOS
Credential	:
Telephone Number	:	208-395-3954

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	05/11/2026

Similar Medicare Providers

1215525902 — AUGUST VOJDANI PA-C
Practice Location Address:

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841

1902916687 — RALEYS OF NEW MEXICO INC
Practice Location Address:

2910 JUAN TABO BLVD NE
ALBUQUERQUE, NM
87112-1828

Practice Phone: 505-299-8600
Practice Fax: 505-299-8609

1619221355 — MAURICE SCHAUFFERT PHARM.D.
Practice Location Address:

2910 JUAN TABO BLVD NE , PHARMACY
ALBUQUERQUE, NM
87112-1828

Practice Phone: 505-299-8600
Practice Fax:

1154625267 — MS. DEBBIE ANN BAXTER
Practice Location Address:

9677 EAGLE RANCH RD NW , APT. 1828
ALBUQUERQUE, NM
87114-5854

Practice Phone: 505-515-1281
Practice Fax:

1720881600 — DEBRILLA MARIE RATCHFORD
Practice Location Address:

1709 MOON ST NE
ALBUQUERQUE, NM
87112-3935

Practice Phone: 505-271-0329
Practice Fax:

1841493491 — COACHES KORNER & THE EMPOWERMENT CENTER OF NEW MEXICO LLC
Practice Location Address:

2040 MOON ST NE
ALBUQUERQUE, NM
87112-2709

Practice Phone: 505-203-6164
Practice Fax:

Directions to “UNITED SUPERMARKETS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.