Provider Demographics
NPI:1558440891
Name:SUPER D DRUGS ACQUISITION CO
Entity Type:Organization
Organization Name:SUPER D DRUGS ACQUISITION CO
Other - Org Name:USA DRUG EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:501-296-3312
Mailing Address - Street 1:2100 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1734
Mailing Address - Country:US
Mailing Address - Phone:501-296-3312
Mailing Address - Fax:501-296-3310
Practice Address - Street 1:300 EAST 8TH STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833
Practice Address - Country:US
Practice Address - Phone:479-495-5444
Practice Address - Fax:479-495-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR013338333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0420505OtherNCPDP