Organization
SUPER D DRUGS ACQUISITION CO
Active
Other names
SUPER D EXPRESS RX
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE STROM (RETAIL SUPPORT)
(501) 296-3312
Entity
Organization
Contact information
Practice address
201 S 28TH AVENUE, HATTIESBURG, MS 39401
(601) 261-6150
(601) 261-6154
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
03154012
MS
333600000X
Pharmacy
03154/01.2
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330365
—
MS
01
—
2518415
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
330365
—
MS
01
—
3976390
MEDICAID DME
MS
Enumeration date
10/24/2006
Last updated
11/16/2007
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