Super D Drugs Acquisition Co.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SUPER D DRUGS ACQUISITION CO.

Doing business as

Super D Drugs #4

Practice address

1028 N Washington Ave
Cookeville, TN 38501-1834

Phone

(931) 526-9786

Fax

(931) 520-0936

NPI assigned

Oct 23, 2006

Last updated

Nov 18, 2008By 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

Mr. Gary M. Boone

Title

Director of HME Operations

Phone

(479) 394-6363

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• SUPER D DRUGS #4 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Walgreen Co

  dba Walgreens #04349

  • Pharmacy
  • Chicago, IL
  • NPI 1184630667

  Member Of

  NPD member

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226966400000",
    "number": "1780767194",
    "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": "1028 N WASHINGTON AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385011834",
            "telephone_number": "931-526-9786",
            "fax_number": "931-520-0936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2008-11-18",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "1897",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TN",
            "license": "1897",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9440786",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "1452309",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FLU",
            "identifier": "3914212",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4403438",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER D DRUGS #4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Delaney Jaid Sullivan
• Emma Leigh Sullivan, NP
• Summit Medical Group PLLC (Upper Cumberland Family Physicians)
• Summit Medical Group,PLLC (Summit Medical Group of Cookeville)
• Sun-Forsythe, PLLC (Nashville Pain Center at Cookeville)
• Erica L Sussex-Grant, D.C.
• Karen D Sussman, NP
• Kristy Sutton, R.PH.
• Angeli B Swallows, AGPCNP-BC
• Virginia Lane Swartz, APRN-BC,PNP

• Community/Retail Pharmacy in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.