Organization
SUPER D DRUGS ACQUISTION CO.
Active
Other names
Jim Bain's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID STROUD RPH (VP PHARMACY SERVICES)
(501) 296-3311
Entity
Organization
Contact information
Practice address
367 N GLOSTER ST, TUPELO, MS 38804-3633
(662) 844-4530
(662) 844-9927
Mailing address
367 N GLOSTER ST, TUPELO, MS 38804-3633
(662) 844-4530
(662) 844-9927
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
04930/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00440682
MEDICAID DME
MS
01
—
00M4996
EDI DME
MS
Enumeration date
07/19/2005
Last updated
07/16/2008
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