Organization
SUPER D DRUGS ACQUISITION CO, INC.
Active
Parent organization
WALGREEN CO
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALGREEN CO
Authorized official
KERMIT R CRAWFORD (PRESIDENT)
(847) 315-3154
Entity
Organization
Contact information
Practice address
2049 E SHILOH RD, CORINTH, MS 38834-3726
(662) 286-6914
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
(217) 709-2386
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
01049/01.1
MS
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
01049/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00045061
DME MEDICAID
MS
01
—
00093009
MEDICAID PHARMACY
MS
01
—
0308160001
MEDICARE
MS
01
—
2508224
NCPDP
MS
Enumeration date
04/17/2008
Last updated
12/26/2012
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