Provider Demographics
NPI:1659808434
Name:UNITED SUPERMARKETS, LLC
Entity Type:Organization
Organization Name:UNITED SUPERMARKETS, LLC
Other - Org Name:UNITED PHARMACY #552
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIT & COMPLIANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-791-8113
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:806-791-8113
Mailing Address - Fax:806-791-7490
Practice Address - Street 1:6313 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4006
Practice Address - Country:US
Practice Address - Phone:806-784-1515
Practice Address - Fax:806-784-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX314913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX471200Medicaid
TX31491OtherTSBP
TX5922097OtherNCPDP #
TX5922097OtherNCPDP #