Organization
SUPERMOMMY'S SUPERSTORE, LLC
Active
Other names
Supermommy's Superstore
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REGINA RAE HAGAN (OWNER)
(270) 769-6693
Entity
Organization
Contact information
Practice address
2411 RING RD, SUITE 105, ELIZABETHTOWN, KY 42701-5929
(270) 769-6693
(270) 769-0911
Mailing address
PO BOX 268, RINEYVILLE, KY 40162-0268
(270) 769-6693
(270) 769-0911
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/03/2009
Last updated
06/03/2009
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