# 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:** 1245313659
- **Authorized official:** JOYCE STROM (RETAIL SUPPORT)
- **Authorized official phone:** (501) 296-3312

## Contact information

- **Practice address:** 6396 HIGHWAY 51 N, HORN LAKE, MS 38637-2411
- **Practice address phone:** (662) 342-1550
- **Practice address fax:** (662) 342-2094
- **Mailing address:** 2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 02075012 | MS | — |
| 333600000X | Pharmacy | 02075/01.2 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 11/16/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330367 | — | MS |
| 01 | — | 00440435 | MEDICAID DME | MS |
| 01 | — | 2511841 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |
| 05 | — | 330367 | — | MS |
| 01 | — | 4582057 | MEDICAID DME | TN |