Provider Demographics
NPI:1609911338
Name:SUPER D DRUG ACQUISITION CO
Entity Type:Organization
Organization Name:SUPER D DRUG ACQUISITION CO
Other - Org Name:STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SERVICES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-296-3337
Mailing Address - Street 1:916 W KEISER AVE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-2912
Mailing Address - Country:US
Mailing Address - Phone:501-296-3337
Mailing Address - Fax:501-296-3310
Practice Address - Street 1:916 W KEISER AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-2912
Practice Address - Country:US
Practice Address - Phone:500-296-3337
Practice Address - Fax:501-296-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR053993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0405399OtherNCDPD OR NAPB NUMBER
AR100466407Medicaid
AR117355716Medicaid
ARAS3212545OtherDEA NUMBER