Organization
SUPER D DRUG ACQUISITION CO.
Active
Other names
SUPER D DRUGS #134
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY M. BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
700 W POPLAR AVE, COLLIERVILLE, TN 38017-2542
(901) 853-2222
(901) 854-6930
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1921
TN
333600000X
Pharmacy
1921
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00440586
MEDICAID DME
MS
01
—
1452333
MEDICAID DME
TN
01
—
3914212
MEDICARE FLU
TN
01
—
4421549
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
9449036
—
TN
Enumeration date
10/23/2006
Last updated
10/23/2008
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