OrganizationSuper D Drugs Acquisition Co.(Super D Express Rx #8407)Durable Medical Equipment & Medical SuppliesSuppliersPractice Address1465 N Westwood Blvd, Poplar Bluff, MO 63901-3315(573) 686-1461(479) 394-6363PECOS EnrollmentBased on the most recent information from CMS, provider Super D Drugs Acquisition Co. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 44 days ago.Profile DetailsProvider ID1962549709Provider TypeOrganizationFull NameSuper D Drugs Acquisition Co.Other NameSuper D Express Rx #8407SubpartNoEnumeration Date1/31/2007Last Updated1/9/2010Contact InformationPractice LocationPractice Address1465 N Westwood Blvd, Poplar Bluff, MO 63901-3315Phone(573) 686-1461Fax(573) 785-0831Mailing LocationMailing Address803 Highway 71 N, Mena, AR 71953-4367Phone(479) 394-6363Fax(479) 394-1046Authorized OfficialNameBoone, Gary (Director Of Hme Operations)Phone(479) 394-6363Provider TaxonomiesCodeDescriptionLicenseCode332B00000XPrimaryDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID620200402DescriptionMedicaidIssuerUnlistedMissouri