Organization
SUPERCO INC
Active
Other names
Battlefield Discount Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
STOREY JOHN RPH (OWNER)
(601) 636-3374
Entity
Organization
Contact information
Practice address
3040A INDIANA AVE, VICKSBURG, MS 39180-4355
(601) 636-3374
(601) 638-5376
Mailing address
3040A INDIANA AVE, VICKSBURG, MS 39180
(601) 636-3374
(601) 638-5376
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
01368/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00095419
—
MS
01
—
2044424
PK
—
Enumeration date
12/04/2006
Last updated
07/19/2018
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