Super D Drugs Acquisition Co.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SUPER D DRUGS ACQUISITION CO.

Practice address

1465 N Westwood Blvd
Poplar Bluff, MO 63901-3315

Phone

(573) 686-1461

Fax

(573) 785-0831

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Gary Boone

Title

Director of HME Operations

Phone

(479) 394-6363

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Super D Express Rx #8407 Doing business as

Member of 1

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

• Walgreen Co

  • Pharmacy
  • South Chicago Heights, IL
  • NPI 1538175096

  Member Of

  NPD member

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262995200000",
    "number": "1962549709",
    "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": "1465 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013315",
            "telephone_number": "573-686-1461",
            "fax_number": "573-785-0831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2010-01-09",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "DIRECTOR OF HME OPERATIONS",
        "authorized_official_telephone_number": "479-394-6363"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620200402",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super D Express Rx #8407",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Felicia Strickland
• Bradley J Stuckenschneider, M.D.
• Aurora Marie Stucker
• Lyrra Suszanne Stucker, RN
• Kenneth Charles Studyvin, D.O.
• Kirit D Sutaria, MD
• Madison Rose Sutton
• Rangsan Suvan, MD
• Aftan Swindle, PHARMD
• Switzer RCF, LLC

• Durable Medical Equipment & Medical Supplies in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Durable Medical Equipment & Medical Supplies in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2010; 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.