Provider Demographics
NPI:1528141736
Name:SUPER D DISCOUNT DRUGS
Entity type:Organization
Organization Name:SUPER D DISCOUNT DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SHUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-925-4932
Mailing Address - Street 1:855 WAYNE RD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1527
Mailing Address - Country:US
Mailing Address - Phone:731-925-4932
Mailing Address - Fax:731-926-2240
Practice Address - Street 1:855 WAYNE RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-1527
Practice Address - Country:US
Practice Address - Phone:731-925-4932
Practice Address - Fax:731-926-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TN14283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4412447OtherNABP NUMBER
TN0124270001Medicare NSC