Provider Demographics
NPI:1750555447
Name:SUPERMARKET INVESTORS INC.
Entity type:Organization
Organization Name:SUPERMARKET INVESTORS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:501-570-0007
Mailing Address - Street 1:8109 INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4840
Mailing Address - Country:US
Mailing Address - Phone:501-570-0007
Mailing Address - Fax:501-565-3975
Practice Address - Street 1:8109 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4840
Practice Address - Country:US
Practice Address - Phone:501-570-0007
Practice Address - Fax:501-565-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy