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Contact Information

SUPERVALUE PHARMACY
210 A VETERANS BLVD N
EUPORA, MS39744
 Phone: 662-258-6710
 Fax: 662-258-5961
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Compounding Pharmacy

3336C0004X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for SUPERVALUE PHARMACY

NPI Number 1700943180
LBN Legal business name SUPERVALUE PHARMACY
Authorized official H BAGWELL - (PIC)
Entity Organization
Organization subpart 1 No
Enumeration date 01/03/2007
Last updated 09/12/2007 - About 19 years ago
Identifiers
MS License # 02200012
Other 2586002 OTHER ID NUMBER
Other 2586002 OTHER ID NUMBER-COMMERCIAL NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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