Organization
UNITED SUPERMARKETS LLC
Active
Other names
MARKET STREET PHARMACY #553, MARKET STREET PHARMACY #2553
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
4425 19TH ST, LUBBOCK, TX 79407-2408
(806) 788-2015
(806) 788-2016
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21408
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148892601
—
TX
01
—
2098859
PK
—
05
—
465189
—
TX
Enumeration date
01/03/2006
Last updated
04/27/2026
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