Organization
UNITED SUPERMARKETS LLC
Active
Other names
UNITED PHARMACY #3552, UNITED PHARMACY #552
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
6313 4TH ST, LUBBOCK, TX 79416-4006
(806) 784-1515
(806) 784-1516
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31491
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31491
TSBP
TX
05
—
471200
—
TX
01
—
5922097
NCPDP #
TX
Enumeration date
05/11/2017
Last updated
05/12/2026
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