Organization
SUPER D DRUGS ACQUISITION CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BOONE (DIRECTOR HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
212 W MAIN ST, MALDEN, MO 63863-2114
(573) 276-2218
(573) 276-4785
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620202408
—
MO
Enumeration date
11/10/2005
Last updated
02/26/2010
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