NPIMap

Organization Active NPI

Super D Drugs Acquisition Co

Doing business as Super D Express RX

  • Community/Retail Pharmacy
  • Hattiesburg, MS
National Provider Identifier
1295818821
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
Doing business as
Super D Express RX
Practice address
201 S 28TH Avenue
Hattiesburg, MS 39401
Phone
(601) 261-6150
Fax
(601) 261-6154
NPI assigned
Oct 24, 2006
Last updated
Nov 16, 2007By the provider in NPPES
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 03154012 MS
Pharmacy 333600000X 03154/01.2 MS
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

201 S 28TH Avenue
Hattiesburg, MS 39401

Mailing address

2100 Brookwood Dr
Little Rock, AR 72202-1734

Other identifiers 4

IdentifierTypeStateIssuer
2518415OtherOTHER ID NUMBER-COMMERCIAL NUMBER
330365MedicaidMS
3976390OtherMSMEDICAID DME
00330365MedicaidMS

Other names 1

  • SUPER D EXPRESS RX 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

201 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-6150

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1295818821",
    "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": "201 S 28TH AVENUE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39401",
            "telephone_number": "601-261-6150",
            "fax_number": "601-261-6154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "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": "03154012",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "03154/01.2",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2518415",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330365",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "3976390",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330365",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER D EXPRESS RX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, 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.