Organization
SUPER D DRUGS ACQUISITION CO
Active
Other names
JIMS DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID STROUD (VP PHARMACY SERVICES)
(501) 296-3311
Entity
Organization
Contact information
Practice address
1027 MINERAL WELLS AVE STE 2, PARIS, TN 38242-4908
(731) 642-6840
(731) 642-9879
Mailing address
PO BOX 757810, MEMPHIS, TN 38175-7810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1061
TN
333600000X
Pharmacy
C1061
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3537701
MEDICAID DME
TN
01
—
4410851
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/14/2006
Last updated
12/03/2007
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