Organization
UNITED SUPERMARKETS LLC
Active
Other names
UNITED PHARMACY #0167, United Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
505 S ACCESS RD W, CLYDE, TX 79510-3660
(325) 893-4297
(325) 225-0168
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
30903
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110426
—
TX
01
—
2159530
PK
—
Enumeration date
11/01/2006
Last updated
03/09/2026
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