Organization
SUPER D DRUG ACQUISITION CO., INC.
Active
Other names
Vital Care of Oxford
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BOONE (PRESIDENT)
(662) 234-7666
Entity
Organization
Contact information
Practice address
1201 OFFICE PARK DR, SUITE 2, OXFORD, MS 38655-3598
(662) 234-7666
(662) 236-1211
Mailing address
PO BOX 5047, MERIDIAN, MS 39302-5047
(800) 447-4095
(601) 482-7490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
04340/02.1
MS
332BC3200X
Customized Equipment (DME)
04340/02.1
MS
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
04340/02.1
MS
332BX2000X
Oxygen Equipment & Supplies (DME)
04340/02.1
MS
333600000X
Pharmacy
04340/02.1
MS
3336C0003X
Community/Retail Pharmacy
04340/02.1
MS
3336H0001X
Home Infusion Therapy Pharmacy
04340/02.1
MS
3336L0003X
Long Term Care Pharmacy
04340/02.1
MS
3336M0002X
Mail Order Pharmacy
04340/02.1
MS
3336S0011X
Specialty Pharmacy
Primary
04340/02.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040337
—
MS
05
—
00330376
—
MS
01
—
640870044003
CHAMPUS/TRICARE
—
Enumeration date
07/11/2006
Last updated
09/11/2025
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