# SUPER D DRUGS ACQUISITION CO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SUPER D DRUGS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154404564
- **Authorized official:** JOYCE STROM (RETAIL SUPPORT)
- **Authorized official phone:** (501) 296-3312

## Contact information

- **Practice address:** 2055 RAYMOND RD, JACKSON, MS 39204-4131
- **Practice address phone:** (601) 372-0662
- **Practice address fax:** (601) 372-0667
- **Mailing address:** 2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 01012012 | MS | — |
| 333600000X | Pharmacy | 01012/01.2 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 11/19/2007

## 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 |