Supervalue Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

02200012 Issued in MS

Legal business name

SUPERVALUE PHARMACY

Practice address

210 A Veterans Blvd N
Eupora, MS 39744

Phone

(662) 258-6710

Fax

(662) 258-5961

NPI assigned

Jan 3, 2007

Last updated

Sep 12, 2007By 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

H Bagwell, RPH

Title

Pic

Phone

(662) 258-6710

Specialties & licenses 4

Addresses

Other identifiers 2

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189555200000",
    "number": "1700943180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 A VETERANS BLVD N",
            "city": "EUPORA",
            "state": "MS",
            "postal_code": "39744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 A VETERANS BLVD N",
            "city": "EUPORA",
            "state": "MS",
            "postal_code": "39744",
            "telephone_number": "662-258-6710",
            "fax_number": "662-258-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERVALUE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-09-12",
        "status": "A",
        "authorized_official_last_name": "BAGWELL",
        "authorized_official_first_name": "H",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "662-258-6710",
        "authorized_official_credential": "RPH"
    },
    "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": "MS",
            "license": "02200012",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2586002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2586002",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Abby Sutton, FNP C
• Charles P Tillman Jr., O.D.
• Laurie Turnipseed, PHARM.D.
• Christy Vowell, D.O.
• Walgreen Co (Murphy Drug #15804, Powered by Walgreens)

• Community/Retail Pharmacy in Eupora, MS
• Providers in Eupora, 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 Sep 12, 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.