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NPI Code Detail

MEDICARE: SUPERMARKET INVESTORS INC

MEDICARE: SUPERMARKET INVESTORS INC
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
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacyAR20178AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10420668OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1619025616
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPERMARKET INVESTORS INC
Provider Business Mailing Address
First Line : 10901 N RODNEY PARHAM RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72212-4114
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10901 N RODNEY PARHAM RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72212-4114
Country : US
Telephone Number : 501-224-5678
Fax Number : 501-227-0183
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : BRENDA MCCRADY
Credential : BS PHARMACY
Telephone Number : 501-570-0007
Provider Enumeration Date : 01/08/2007
Last Update Date : 12/05/2007

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1083640072 — ROY STEVEN JONES M.D.
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1205850682 — DR. ROBERT PAUL SVOBODA MD
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1730398660 — DHAVAL H PATEL MD
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1811198070 — DAVID P MCELREATH D.O.
Practice Location Address:
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Practice Fax: 501-406-9265

Directions to “SUPERMARKET INVESTORS INC ” Practice Location

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