Provider Demographics
NPI:1255479341
Name:UNITED SUPERMARKETS, LTD.
Entity Type:Organization
Organization Name:UNITED SUPERMARKETS, LTD.
Other - Org Name:UNITED PHARMACY 425
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AND CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-791-0220
Mailing Address - Street 1:7830 ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1942
Mailing Address - Country:US
Mailing Address - Phone:806-791-0220
Mailing Address - Fax:806-791-7490
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-2659
Practice Address - Country:US
Practice Address - Phone:806-435-3636
Practice Address - Fax:806-436-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX466332Medicaid