Organization
SUPER D DRUG ACQUISITION CO.
Active
Other names
USA DRUG EXPRESS #1006
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
4010 W 12TH ST, LITTLE ROCK, AR 72204-2047
(501) 663-9497
(501) 664-5019
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
AR20066
AR
333600000X
Pharmacy
AR20066
AR
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401048
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
10615
MEDICARE FLU
AR
05
—
133660407
—
AR
01
—
135607716
MEDICAID DME
AR
Enumeration date
10/23/2006
Last updated
10/22/2008
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