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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
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12151899OTHERPK

General Provider Information

NPI Number : 1881071512
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 : 300 E COMMERCE ST
Second Line :
City : BROWNWOOD
State : TX
Zip : 76801-1824
Country : US
Telephone Number : 325-510-3400
Fax Number : 325-488-6087
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 05/01/2015
Last Update Date : 03/18/2026

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Directions to “UNITED SUPERMARKETS LLC ” Practice Location

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