Organization
UNITED SUPERMARKETS LLC
Active
Other names
AMIGOS PHARMACY #503, AMIGOS PHARMACY #2603
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
112 N UNIVERSITY AVE, LUBBOCK, TX 79415-2822
(806) 763-5908
(806) 741-0618
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
21383
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148859501
—
TX
05
—
159822901
—
TX
01
—
2101193
PK
—
05
—
465171
—
TX
Enumeration date
11/03/2005
Last updated
05/11/2026
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