NPIMap

Organization Active NPI

Super D Drugs Acquisition Co

  • Community/Retail Pharmacy
  • Horn Lake, MS
National Provider Identifier
1245313659
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SUPER D DRUGS ACQUISITION CO
Practice address
6396 Highway 51 N
Horn Lake, MS 38637-2411
Phone
(662) 342-1550
Fax
(662) 342-2094
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 02075012 MS
Pharmacy 333600000X 02075/01.2 MS
Community/Retail Pharmacy 3336C0003X Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

6396 Highway 51 N
Horn Lake, MS 38637-2411

Mailing address

2100 Brookwood Dr
Little Rock, AR 72202-1734

Other identifiers 5

IdentifierTypeStateIssuer
330367MedicaidMS
00440435OtherMSMEDICAID DME
2511841OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4582057OtherTNMEDICAID DME
00330367MedicaidMS

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

6396 Highway 51 N
Horn Lake, MS 38637
Phone (662) 342-1550

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": "1195171200000",
    "number": "1245313659",
    "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": "6396 HIGHWAY 51 N",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386372411",
            "telephone_number": "662-342-1550",
            "fax_number": "662-342-2094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-11-16",
        "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": "02075012",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "02075/01.2",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330367",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "00440435",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2511841",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "4582057",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330367",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER D DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Horn Lake, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.