Active NPI
Super Pharmacy LLC
- Community/Retail Pharmacy
- Washington, DC
National Provider Identifier
1871608166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- RX9500254
- Legal business name
- SUPER PHARMACY LLC
- Practice address
- 1019 H St NE
Washington, DC 20002-3743 - Phone
- (202) 388-0050
- Fax
- (202) 388-0047
- NPI assigned
- Aug 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Enock K Adewuyi, PHD
- Title
- Chief Operating Officer
- Phone
- (202) 388-0050
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | RX9500254 | DC | Primary |
Addresses
Primary practice location
1019 H St NE
Washington, DC 20002-3743
Mailing address
1019 H St NE
Washington, DC 20002-3743
Phone (202) 388-0050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0903458 | Other | NAPB | |
| 017028900 | Medicaid | DC |
National Provider Directory
National Provider Directory- Tax ID family
- Super Pharmacy LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Washington, DC
- NPI 1548308562
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1871608166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 H ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200023743",
"telephone_number": "202-388-0050",
"fax_number": "202-388-0047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1019 H ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200023743",
"telephone_number": "202-388-0050",
"fax_number": "202-388-0047"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUPER PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-20",
"last_updated": "2023-03-07",
"certification_date": "2020-01-02",
"status": "A",
"authorized_official_last_name": "ADEWUYI",
"authorized_official_first_name": "ENOCK",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
"authorized_official_telephone_number": "202-388-0050",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHD"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "DC",
"license": "RX9500254",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NAPB",
"identifier": "0903458",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "017028900",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.