Organization
UNITED SUPERMARKETS, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM PURSER RPH (THIRD PARTY ADMINISTRATOR)
(806) 791-0220
Entity
Organization
Contact information
Practice address
5605 COLLEYVILLE BLVD, COLLEYVILLE, TX 76034-6022
(817) 577-5030
(817) 577-5035
Mailing address
7830 ORLANDO AVE, LUBBOCK, TX 79423-1942
(806) 791-0220
(806) 791-7490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
22751
TX
333600000X
Pharmacy
Primary
22751
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4529799
NCPDP
TX
05
—
465443
—
TX
01
—
PH0436
PROVIDER#
TX
Enumeration date
12/30/2005
Last updated
10/17/2007
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