Organization
SUPER D DRUGS ACQUISITION CO.
Active
Other names
SUPER D DRUGS #139
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD COOPER (DIRECTOR OF HME OPERATIONS)
(501) 296-3337
Entity
Organization
Contact information
Practice address
3012 HIGHWAY 80 E, PEARL, MS 39208-3497
(601) 939-4813
(601) 939-2749
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
(501) 296-3337
(501) 296-3310
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
01918012
MS
333600000X
Pharmacy
01918/01.2
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330375
—
MS
01
—
00440585
MEDICAID DME
MS
01
—
2514506
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
330375
—
MS
01
—
870001323
MEDICARE FLU
MS
Enumeration date
10/24/2006
Last updated
01/26/2012
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