Freds Westside Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

FREDS WESTSIDE PHARMACY INC

Practice address

207 Kirkwood St
Picayune, MS 39466-3835

Phone

(601) 798-8888

Fax

(601) 799-1012

NPI assigned

Oct 11, 2006

Last updated

Aug 5, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Roger G Cruse

Title

Owner

Phone

(601) 798-8888

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1265520290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 KIRKWOOD ST",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394663835",
            "telephone_number": "601-798-8888",
            "fax_number": "601-799-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 KIRKWOOD ST",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394663835",
            "telephone_number": "601-798-8888",
            "fax_number": "601-799-1012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS WESTSIDE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "CRUSE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-798-8888"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330105",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DMERC",
            "identifier": "01786239",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Picayune, MS
• Providers in Picayune, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.