Organization
SUPER D DRUG ACQUISITION CO.
Active
Other names
Holly's Health Mart #23
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY M. BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
1430 W 1ST ST N, PRESCOTT, AR 71857-3339
(870) 887-2717
(870) 887-2113
Mailing address
1430 W 1ST ST N, PRESCOTT, AR 71857-3339
(870) 887-2717
(870) 887-2113
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
65694
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0417926
PHARMACY
AR
05
—
165425407
—
AR
Enumeration date
06/27/2005
Last updated
11/12/2009
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