Organization
UNITED SUPERMARKETS LLC
Active
Other names
UNITED PHARMACY #4515
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
311 S AVENUE D, BURKBURNETT, TX 76354-3541
(940) 569-3319
(940) 569-5359
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
21389
TX
333600000X
Pharmacy
21389
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149313201
—
TX
01
—
4576344
NCPDP
TX
05
—
465178
—
TX
Enumeration date
11/03/2005
Last updated
03/18/2026
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