Organization
SUPER D DRUGS ACQUISITION CO.
Active
Other names
Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
513 N GRAND AVE, DONIPHAN, MO 63935-1405
(573) 996-3784
(573) 996-5275
Mailing address
803 HIGHWAY 71 N, MENA, AR 71953-4367
(479) 394-6363
(479) 394-1046
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
02/02/2010
Last updated
02/02/2010
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