NPIMap

Organization Active NPI

Super D Drugs Acquisition Co

  • Community/Retail Pharmacy
  • Harrison, AR
National Provider Identifier
1962553941
Registry record updated Nov 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
AR19021 Issued in AR
Legal business name
SUPER D DRUGS ACQUISITION CO
Practice address
124 W Stephenson Ave
Harrison, AR 72601-4224
Phone
(870) 741-2361
Fax
(870) 741-9747
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2008

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X AR19021 AR Primary

Addresses

Primary practice location

124 W Stephenson Ave
Harrison, AR 72601-4224

Mailing address

USA Drug Lockbox 14226
Chicago, IL 60693-0001

Other identifiers 2

IdentifierTypeStateIssuer
127265407MedicaidAR
0419021OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • SIMS DRUG 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

124 W Stephenson Ave
Harrison, AR 72601
Phone (870) 741-2361

14226 Usa Drug Lockbox
Chicago, IL 60693

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227225600000",
    "number": "1962553941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "USA DRUG LOCKBOX 14226",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606930001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W STEPHENSON AVE",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726014224",
            "telephone_number": "870-741-2361",
            "fax_number": "870-741-9747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER D DRUGS ACQUISITION CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2008-11-21",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR19021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127265407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0419021",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIMS DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harrison, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.