NPIMap

Organization Active NPI

Super D Drugs Acquisition Co.

Doing business as Medical Center Pharmacy

  • Community/Retail Pharmacy
  • Doniphan, MO
National Provider Identifier
1366774374
Registry record updated Feb 2, 2010
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
Medical Center Pharmacy
Practice address
513 N Grand Ave
Doniphan, MO 63935-1405
Phone
(573) 996-3784
Fax
(573) 996-5275
NPI assigned
Feb 2, 2010
Last updated
Feb 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2010

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

Authorized official

Name
Gary Boone
Title
Director of HME Operations
Phone
(479) 394-6363

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X
Oxygen Equipment & Supplies (DME) 332BX2000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

513 N Grand Ave
Doniphan, MO 63935-1405

Mailing address

803 Highway 71 N
Mena, AR 71953-4367
Phone (479) 394-6363

Other names 1

  • Medical Center Pharmacy 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

NPI Registry JSON

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

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265068800000",
    "number": "1366774374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 HIGHWAY 71 N",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719534367",
            "telephone_number": "479-394-6363",
            "fax_number": "479-394-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 N GRAND AVE",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "639351405",
            "telephone_number": "573-996-3784",
            "fax_number": "573-996-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2010-02-02",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "DIRECTOR OF HME OPERATIONS",
        "authorized_official_telephone_number": "479-394-6363"
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Doniphan, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; 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.