NPIMap

Organization Active NPI

Super D Drug Acquisition Co.

  • Pharmacy
  • Prescott, AR
National Provider Identifier
1528064367
Registry record updated Nov 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
65694 Issued in AR
Legal business name
SUPER D DRUG ACQUISITION CO.
Practice address
1430 W 1St St N
Prescott, AR 71857-3339
Phone
(870) 887-2717
Fax
(870) 887-2113
NPI assigned
Jun 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 65694 AR Primary

Addresses

Primary practice location

1430 W 1St St N
Prescott, AR 71857-3339

Mailing address

1430 W 1St St N
Prescott, AR 71857-3339
Phone (870) 887-2717

Other identifiers 2

IdentifierTypeStateIssuer
165425407MedicaidAR
0417926OtherARPHARMACY

Other names 1

  • Holly's Health Mart #23 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

1430 W 1st St N
Prescott, AR 71857
Phone (870) 887-2717

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1528064367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 W 1ST ST N",
            "city": "PRESCOTT",
            "state": "AR",
            "postal_code": "718573339",
            "telephone_number": "870-887-2717",
            "fax_number": "870-887-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 W 1ST ST N",
            "city": "PRESCOTT",
            "state": "AR",
            "postal_code": "718573339",
            "telephone_number": "870-887-2717",
            "fax_number": "870-887-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUG ACQUISITION CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DIRECTOR OF HME OPERATIONS",
        "authorized_official_telephone_number": "479-394-6363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AR",
            "license": "65694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165425407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY",
            "identifier": "0417926",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holly's Health Mart #23",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; 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.