Provider Demographics
NPI:1942202239
Name:UNITED SUPERMARKETS, L.L.C.
Entity Type:Organization
Organization Name:UNITED SUPERMARKETS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PURSER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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 1:7830 ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1942
Practice Address - Country:US
Practice Address - Phone:806-791-0220
Practice Address - Fax:806-791-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4581496333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4077810002Medicare NSC
TX4077810009Medicare NSC
TX4077810010Medicare NSC
TXPH0341Medicare PIN
TX4077810015Medicare NSC
TX4077810013Medicare NSC
TX4077810019Medicare NSC
TX4077810006Medicare NSC
TX4077810016Medicare NSC
TX4077810008Medicare NSC
TX4077810012Medicare NSC
TX4077810003Medicare NSC
TX4077810005Medicare NSC
TX4077810007Medicare NSC
TX4077810017Medicare NSC
TX4077810020Medicare NSC
TX4077810001Medicare NSC
TX4077810004Medicare NSC
TX4077810011Medicare NSC
TX4077810014Medicare NSC