Super D Drugs Acquisition Co.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SUPER D DRUGS ACQUISITION CO.

Practice address

3012 Highway 80 E
Pearl, MS 39208-3497

Phone

(601) 939-4813

Fax

(601) 939-2749

NPI assigned

Oct 24, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Chad Cooper

Title

Director of HME Operations

Phone

(501) 296-3337

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• SUPER D DRUGS #139 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Walgreen Co

  • Pharmacy
  • South Chicago Heights, IL
  • NPI 1538175096

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James W. Hanson, RPH

  • Pharmacist
  • Pearl, MS
  • NPI 1376728683
  NPD (past)

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1306929922",
    "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",
            "telephone_number": "501-296-3337",
            "fax_number": "501-296-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 HIGHWAY 80 E",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392083497",
            "telephone_number": "601-939-4813",
            "fax_number": "601-939-2749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "DIRECTOR OF HME OPERATIONS",
        "authorized_official_telephone_number": "501-296-3337",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "01918012",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "01918/01.2",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "330375",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2514506",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FLU",
            "identifier": "870001323",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330375",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "00440585",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER D DRUGS #139",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Helen Stephenson
• Fairest Stevenson-Matthews, DNP, MSN, RN
• Candace Stewart, NP
• Sonja T Stiff, D.M.D.
• Emily Pate Suggs, LPC
• Barbara L Tapps, FNP
• Tara Pharmacy SE LLC
• The Medical Foundation of Central Mississippi
• The Pediatric Dental Studio, LLC
• Deidra Thompson, FNP

• Community/Retail Pharmacy in Pearl, MS
• Providers in Pearl, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; 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.