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 4 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