Organization
SUPER D DRUGS ACQUISITION CO
Active
Other names
SIMS DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY M. BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
124 W STEPHENSON AVE, HARRISON, AR 72601-4224
(870) 741-2361
(870) 741-9747
Mailing address
USA DRUG LOCKBOX 14226, CHICAGO, IL 60693-0001
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
AR19021
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0419021
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
127265407
—
AR
Enumeration date
01/16/2007
Last updated
11/21/2008
Update your record
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