Organization
SUPER D DRUGS ACQUISITION CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
906 N DOUGLASS ST, MALDEN, MO 63863-1514
(573) 276-2737
(573) 276-2496
Mailing address
803 HIGHWAY 71 N, MENA, AR 71953-4367
(479) 394-6363
(479) 394-1046
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
004290
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600096408
—
MO
Enumeration date
03/05/2007
Last updated
03/16/2010
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