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Organization
SUPER D DRUGS ACQUISITION CO
Active
Organization
SUPER D DRUGS ACQUISITION CO
Active
Other names
SUPER D DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE STROM (RETAIL SUPPORT)
(501) 296-3312
Entity
Organization
Contact information
Practice address
2055 RAYMOND RD, JACKSON, MS 39204-4131
(601) 372-0662
(601) 372-0667
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
01012012
MS
333600000X
Pharmacy
01012/01.2
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330373
—
MS
01
—
00440775
MEDICAID DME
MS
01
—
2514114
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
330373
—
MS
Enumeration date
10/23/2006
Last updated
11/19/2007
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