Organization Name: | SUPER D DRUGS ACQUISITION CO |
NPI Number: | 1063595478 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KERMIT R CRAWFORD (PRESIDENT) |
Mailing Address: | 3119 W Capitol St Jackson |
State: | MS US |
Postal Code: | 392094204 |
Phone Number: | 6013523344 |
Fax Number: | 6013523349 |
NPI Enumeration Date: | 10/23/2006 |
NPI Last Update Date: | 10/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 01917012 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |