Pats Super V Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR10821 Issued in AR

Legal business name

PATS SUPER V DRUG STORE INC

Doing business as

Super V Drugs

Practice address

1000 E Matthews Ave
Ste a
Jonesboro, AR 72401-4307

Phone

(870) 972-6470

Fax

(870) 972-0710

NPI assigned

Aug 2, 2006

Last updated

Sep 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristy Reed, PDNPI 1679978043

Title

Owner Phcst

Phone

(870) 972-6470

Specialties & licenses 5

Addresses

Other identifiers 3

Other names 1

• SUPER V DRUGS Doing business as

Medicare fee-for-service enrollment

Enrolled in AR3 enrollments

Enrollment records 3

Tax ID family

Super V Drugs Vaccines3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Pats Super V Drug Store Inc

  • Long Term Care Pharmacy
  • Jonesboro, AR
  • NPI 1457118242
  NPD tax ID
• Super V Drugs Vaccines

  • Community/Retail Pharmacy
  • Jonesboro, AR
  • NPI 1245635572
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kristy Reed

  • Pharmacist
  • Jonesboro, AR
  • NPI 1679978043
  NPD (past) Authorized official
• Melanie Weathers, PHARM D

  • Pharmacist
  • Jonesboro, AR
  • NPI 1750786257
  NPD (past)
• Mollie Wolfe, PHARMD

  • Pharmacist
  • Jonesboro, AR
  • NPI 1275201568
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1487661583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E MATTHEWS AVE",
            "address_2": "STE A",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014307",
            "telephone_number": "870-972-6470",
            "fax_number": "870-972-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E MATTHEWS AVE",
            "address_2": "STE A",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014307",
            "telephone_number": "870-972-6470",
            "fax_number": "870-972-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATS SUPER V DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "OWNER PHCST",
        "authorized_official_telephone_number": "870-972-6470",
        "authorized_official_credential": "PD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR10821",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121246407",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128304716",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1994112",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER V DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Suresh Patel, M.D.
• Zankhana Patel, ATC, LAT
• Kionna Patillo
• Janica Humphrey Patrick, LCSW
• Pats Super V Drug Store Inc
• Jimmy Patteril, DO
• Adam Lewis Patterson
• Casandra Q Patterson, MRC ED.S LPC RPT NCC
• Cody Patterson, O.D.
• Mike Patterson, LPC

• Community/Retail Pharmacy in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.