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	PH00004377	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2058876	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497792915
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	:	2351 MAIN ST SE
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-6320
Country	:	US
Telephone Number	:	505-865-2089
Fax Number	:	505-865-2829

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	05/11/2026

Similar Medicare Providers

1932394467 — THOMAS G STENSLAND RPH
Practice Location Address:

2351 MAIN ST SE
LOS LUNAS, NM
87031-6320

Practice Phone: 505-865-2089
Practice Fax: 505-865-2829

1730675398 — DANIEL GOLDBERG PHARMD
Practice Location Address:

2351 MAIN ST SE
LOS LUNAS, NM
87031-6320

Practice Phone: 505-865-2089
Practice Fax:

1538761044 — LOUIS T ASANGA RPH
Practice Location Address:

2351 MAIN ST SE
LOS LUNAS, NM
87031-6320

Practice Phone: 505-865-2089
Practice Fax:

1639940513 — 1918 WINTER STREET OPERATING CO LLC
Practice Location Address:

2351 MAIN ST SE
LOS LUNAS, NM
87031-6320

Practice Phone: 505-865-2089
Practice Fax: 505-865-2829

1902891773 — ASTRAL PHARMACY INC
Practice Location Address:

6368 HOLLYWOOD BLVD
LOS ANGELES, CA
90028-6320

Practice Phone: 323-466-9931
Practice Fax: 323-466-9932

1184760852 — DR. DANNY SHIRI D.D.S.
Practice Location Address:

6320 COMMODORE SLOAT DR
LOS ANGELES, CA
90048-5444

Practice Phone: 323-936-9102
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.