Provider Demographics
NPI:1568667608
Name:FAMILY ENTERPRISES INC
Entity Type:Organization
Organization Name:FAMILY ENTERPRISES INC
Other - Org Name:SUPER SAVER DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-686-1919
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-1187
Mailing Address - Country:US
Mailing Address - Phone:573-686-1919
Mailing Address - Fax:573-686-8450
Practice Address - Street 1:HWY 53 AND BROADWAY
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63902
Practice Address - Country:US
Practice Address - Phone:573-686-1919
Practice Address - Fax:573-686-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO622198703Medicaid
0861790001Medicare NSC