NPIMap

Organization Active NPI

Super D Drugs Acquisition Co

Doing business as Super D Drugs

  • Community/Retail Pharmacy
  • Jackson, MS
National Provider Identifier
1154404564
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SUPER D DRUGS ACQUISITION CO
Doing business as
Super D Drugs
Practice address
2055 Raymond Rd
Jackson, MS 39204-4131
Phone
(601) 372-0662
Fax
(601) 372-0667
NPI assigned
Oct 23, 2006
Last updated
Nov 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joyce Strom
Title
Retail Support
Phone
(501) 296-3312

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 01012012 MS
Pharmacy 333600000X 01012/01.2 MS
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

2055 Raymond Rd
Jackson, MS 39204-4131

Mailing address

2100 Brookwood Dr
Little Rock, AR 72202-1734

Other identifiers 4

IdentifierTypeStateIssuer
330373MedicaidMS
2514114OtherOTHER ID NUMBER-COMMERCIAL NUMBER
00440775OtherMSMEDICAID DME
00330373MedicaidMS

Other names 1

  • SUPER D DRUGS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Super D Drugs Acquisition Co25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

2055 Raymond Rd
Jackson, MS 39204
Phone (601) 372-0662

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1154404564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 BROOKWOOD DR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722021734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 RAYMOND RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392044131",
            "telephone_number": "601-372-0662",
            "fax_number": "601-372-0667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "STROM",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "RETAIL SUPPORT",
        "authorized_official_telephone_number": "501-296-3312"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "01012012",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "01012/01.2",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330373",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2514114",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "00440775",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330373",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER D DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.