Organization
UNITED SUPERMARKETS LLC
Active
Other names
Market Street Pharmacy #0675, MARKET STREET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
4950 E 42ND ST, ODESSA, TX 79762-7240
(432) 367-4612
(432) 367-1630
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
29388
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2099987
PK
—
05
—
467073
—
TX
Enumeration date
06/02/2006
Last updated
02/18/2026
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