Freds Pharmacy of Quitman
Organization Active NPI Community/Retail Pharmacy · Marks, MS
NPI 1215957428 · NPPES record last updated Nov 12, 2014
Key facts
- NPI
- 1215957428
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 06997011 (MS)
- Legal business name
- FREDS PHARMACY OF QUITMAN
- Practice address
- 1098 Martin Luther King Dr
Marks, MS 38646-1825 - Phone
- (662) 326-9272
- Fax
- (662) 326-5268
- NPI assigned
- Jul 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Ricky Chambers, PHARMD
- Title
- VP
- Phone
- (901) 238-2477
Other NPIs on the same Medicare enrollment 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150218002190 | MS | Part B Supplier - Mass Immunization (Roster Biller Only) | 7810036845 |
4 other NPIs on this enrollment Practice locations: Quitman, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 06997011 | MS | |
| Community/Retail Pharmacy | 3336C0003X | 06997011 | MS | Yes |
Addresses
Primary practice location
1098 Martin Luther King Dr
Marks, MS 38646-1825
Mailing address
1098 Martin Luther King Dr
Marks, MS 38646-1825
Phone (662) 326-9272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03407032 | Medicaid | MS | |
| 2586569 | Other | NCPDP |
Other names
- FRED'S PHARMACY 7601
Other providers in Marks, MS
- Delta Medical Foundation
- Deporres Delta Ministries, Inc.
- Dons Pharmacy Inc
- George Edward Farrell
- Courtney Fortner
- Golden Years Healthcare LLC
- Healthyland Adult Day Care, LLC
- Goly Rice Henry Jr.
- Medstock, Inc.
- Mississippi State Department of Health
All providers in Marks, MS · Community/Retail Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.