Ike'S #1

LBN: Super D Drugs Acquisition, Co.
Ike'S #1 is an health care organization with primary practice located at 5040 Park Ave , Memphis TN 38117-5709. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Eyewear Supplier (Equipment, not the service), Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Super D Drugs Acquisition, Co. can be contacted via phone (901) 761-9570, or through Boone, Gary M. via phone (479) 394-6363.

Contact Information

Primary practice address
5040 Park Ave Memphis TN 38117-5709
Phone: (901) 761-9570
Fax: (901) 682-3266
Website:
Map and Directions
Authorized official contact:
Name: Boone, Gary M.
Phone: (479) 394-6363

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X 2316 Tennessee
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X DPO0000000704 Tennessee
Suppliers / Pharmacy 333600000X 2316 Tennessee
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1679656086
LBN Legal business name Super D Drugs Acquisition, Co.
DBA Doing business as Ike'S #1
Authorized official Boone, Gary M.
Entity Organization
Organization subpart 1 No
Enumeration date Oct 23rd, 2006
Last updated Jul 7th, 2009 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679656086 NPPES
Tennessee Other 00440986 MEDICAID DME
Tennessee Other 870001323 MEDICAID DME
Tennessee Other 4427096 MEDICAID DME
Tennessee MEDICAID 9449785 MEDICAID DME

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