Organization
UNITED SUPERMARKETS LLC
Active
Organization
UNITED SUPERMARKETS LLC
Active
Other names
MARKET STREET PHARMACY, MARKET STREET PHARMACY #0417
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
4590 KELL BLVD, WICHITA FALLS, TX 76309-4713
(940) 716-2515
(940) 310-0315
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
TX21391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149311601
—
TX
05
—
149311601/49311602
—
TX
05
—
149311602
—
TX
01
—
2097259
PK
—
05
—
465180
—
TX
Enumeration date
02/02/2007
Last updated
03/09/2026
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