Organization
SUPER D DRUGS ACQUISITION CO.
Active
Other names
Super D Express Rx #8407
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
1465 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3315
(573) 686-1461
(573) 785-0831
Mailing address
803 HIGHWAY 71 N, MENA, AR 71953-4367
(479) 394-6363
(479) 394-1046
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620200402
—
MO
Enumeration date
01/31/2007
Last updated
01/09/2010
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