MEDICARE: SUPER DRUGS RX 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1427438969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER DRUGS RX LLC

Provider Business Mailing Address
First Line	:	2941 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2802
Country	:	US
Telephone Number	:	215-278-2797
Fax Number	:	215-278-2709

Provider Business Practice Location Address
First Line	:	2941 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2802
Country	:	US
Telephone Number	:	215-278-2797
Fax Number	:	215-278-2709

Authorized Official
Title or Position	:	MEMEBER
Name	:	MAUNIK BHATT
Credential	:
Telephone Number	:	201-270-8459

Provider Enumeration Date	:	05/30/2015
Last Update Date	:	07/30/2024

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