Super D Drug Acquisition Co.
Pharmacy in Prescott, AR. Organization (NPI-2).
NPI number1528064367
StatusActive
Last updated in NPPESNov 12, 2009
Details
- NPI
- 1528064367
- Entity type
- Organization (NPI-2)
- Legal business name
- Super D Drug Acquisition Co.
- Organization subpart
- No
- Enumeration date
- Jun 27, 2005
- Last updated
- Nov 12, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 333600000X | Pharmacy | 65694 | AR | Yes |
Other names
- Holly'S Health Mart #23 (Doing Business As)
Practice location
1430 W 1st St NPrescott, AR 71857-3339
Phone 870-887-2717 · Fax 870-887-2113
Mailing address
1430 W 1st St NPrescott, AR 71857-3339
Phone 870-887-2717 · Fax 870-887-2113
Authorized official
Gary M. Boone
Director Of Hme Operations
4793946363
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