Organization
UNITED SUPERMARKETS LLC
Active
Other names
MARKET STREET PHARMACY #0679, MARKET STREET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
4450 BUFFALO GAP RD, ABILENE, TX 79606-2703
(325) 695-4690
(325) 352-4297
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2099986
PK
—
05
—
470514
—
TX
Enumeration date
06/02/2006
Last updated
03/09/2026
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