Provider Demographics
NPI:1962028902
Name:UNITED SUPERMARKETS, LLC
Entity Type:Organization
Organization Name:UNITED SUPERMARKETS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RX AUDIT & COMPLIANCE SPECIALIST
Authorized Official - Prefix:MRS
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 1:2783 S CEDAR
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772
Practice Address - Country:US
Practice Address - Phone:806-791-8113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy