Organization
SUPER D DRUGS ACQUISITION CO
Active
Other names
SUPER D DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE STROM (RETAIL SUPPORT)
(501) 296-3312
Entity
Organization
Contact information
Practice address
6396 HIGHWAY 51 N, HORN LAKE, MS 38637-2411
(662) 342-1550
(662) 342-2094
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
02075012
MS
333600000X
Pharmacy
02075/01.2
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
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
Enumeration date
10/23/2006
Last updated
11/16/2007
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