Organization
SUPER D DRUGS ACQUISITION CO.
Active
Other names
FORBES REXALL DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
100 N GRAND AVE, HOUSTON, MO 65483-1222
(417) 967-3315
(417) 967-8205
Mailing address
803 HIGHWAY 71 N, MENA, AR 71953-4367
(479) 394-6363
(479) 394-1046
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620662205
—
MO
Enumeration date
07/28/2006
Last updated
04/13/2010
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