NPIMap

Organization Active NPI

Super D Drugs Acquistion Co.

Doing business as Jim Bain's Pharmacy

  • Durable Medical Equipment & Medical Supplies
  • Tupelo, MS
National Provider Identifier
1770582009
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
04930/11.1 Issued in MS
Legal business name
SUPER D DRUGS ACQUISTION CO.
Doing business as
Jim Bain's Pharmacy
Practice address
367 N Gloster St
Tupelo, MS 38804-3633
Phone
(662) 844-4530
Fax
(662) 844-9927
NPI assigned
Jul 19, 2005
Last updated
Jul 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Authorized official

Name
David Stroud, RPHNPI 1932307394
Title
VP Pharmacy Services
Phone
(501) 296-3311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 04930/11.1 MS Primary

Addresses

Primary practice location

367 N Gloster St
Tupelo, MS 38804-3633

Mailing address

367 N Gloster St
Tupelo, MS 38804-3633
Phone (662) 844-4530

Other identifiers 2

IdentifierTypeStateIssuer
00440682OtherMSMEDICAID DME
00M4996OtherMSEDI DME

Other names 1

  • Jim Bain's 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

Locations

367 N Gloster St
Tupelo, MS 38804
Phone (662) 844-4530

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1770582009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 N GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388043633",
            "telephone_number": "662-844-4530",
            "fax_number": "662-844-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 N GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388043633",
            "telephone_number": "662-844-4530",
            "fax_number": "662-844-9927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISTION CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "STROUD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP PHARMACY SERVICES",
        "authorized_official_telephone_number": "501-296-3311",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "04930/11.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "00440682",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDI DME",
            "identifier": "00M4996",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jim Bain's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; 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.