Active NPI
United Supermarkets LLC
Doing business as Market Street Pharmacy #1564
- Community/Retail Pharmacy
- Coppell, TX
National Provider Identifier
1104062280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 26273
- Legal business name
- UNITED SUPERMARKETS LLC
- Doing business as
- Market Street Pharmacy #1564
Market Street Pharmacy #564 - Practice address
- 700 N Denton Tap Rd
Coppell, TX 75019-2162 - Phone
- (469) 322-6815
- Fax
- (469) 983-0943
- NPI assigned
- Dec 19, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 26273 | TX | Primary |
Addresses
Primary practice location
700 N Denton Tap Rd
Coppell, TX 75019-2162
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 470512 | Medicaid | TX | |
| 2118308 | Other | PK |
Other names 2
- MARKET STREET PHARMACY #1564
- Market Street Pharmacy #564
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930024265 | TX | DME Supplier - Pharmacy | 0143126524 | Practice locations: Coppell, TX |
| O20101124000158 | TX | Part B Supplier - Centralized Flu Biller | 0143126524 |
This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D1094222 | Market Street Pharmacy #1564 | Certificate of waiver | Jan 13, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Market Street Pharmacy #1564 | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings | Does not accept assignment |
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Haggen Pharmacy #2102
- Community/Retail Pharmacy
- Grants Pass, OR
- NPI 1063468064
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229644800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1778457600000",
"number": "1104062280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 E PARKCENTER BLVD",
"city": "BOISE",
"state": "ID",
"postal_code": "837063940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 N DENTON TAP RD",
"city": "COPPELL",
"state": "TX",
"postal_code": "750192162",
"telephone_number": "469-322-6815",
"fax_number": "469-983-0943"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNITED SUPERMARKETS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-12-19",
"last_updated": "2026-05-11",
"certification_date": "2026-05-11",
"status": "A",
"authorized_official_last_name": "GIANNAKOPOULOS",
"authorized_official_first_name": "KATHY",
"authorized_official_title_or_position": "ENROLLMENTS MANAGER",
"authorized_official_telephone_number": "208-395-3954"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "26273",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "470512",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2118308",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MARKET STREET PHARMACY #1564",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Market Street Pharmacy #564",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Coppell, TX
- Vinessa Ulanday
- Ulanoski Associates, P.a.
- James Robert Ulanoski, M.D.
- Pamela Alberts Ulanoski, M.D.
- Afia Umber, M.D.
- Unity Coppell (Unity Medical and Wellness Center)
- Urgent Care of Texas PLLC
- V. James Viola & Associates, Inc.
- Vail Physician Services, PLLC (Vail Physician Services)
- Valley Ranch Family Eye Care PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.