Freds Pharmacy of Quitman LLC
Organization Active NPI Community/Retail Pharmacy · Vicksburg, MS
NPI 1306102470 · NPPES record last updated Sep 18, 2012
Key facts
- NPI
- 1306102470
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- FREDS PHARMACY OF QUITMAN LLC
- Practice address
- 1123 Washington St
Vicksburg, MS 39183-2959 - Phone
- (601) 636-2756
- NPI assigned
- Apr 3, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- FREDS PHARMACY OF QUITMAN LLC
Authorized official
- Name
- Rick Chambers
- Title
- Vice President
- Phone
- (901) 238-2477
Other NPIs on the same Medicare enrollment 4
Practitioners 2
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 This NPI is an additional NPI on the enrollment Practice locations: Quitman, MS |
National Provider Directory
- Part of
- Freds Pharmacy of Quitman LLC
Locations
304 W Main St
#7141
Charleston, MS 38921
Phone (662) 647-5541
1039 Martin Luther King Dr
#7061
Marks, MS 38646
Phone (662) 326-9272
1039 Martin Luther King Dr
#7601
Marks, MS 38646
Phone (662) 326-9272
626 22nd Ave S
#7681
Meridian, MS 39301
Phone (601) 701-0019
2431 Clay St
Vicksburg, MS 39183
Phone (601) 636-2756
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1123 Washington St
Vicksburg, MS 39183-2959
Mailing address
PO Box 5105
Meridian, MS 39302-5105
Phone (601) 693-2655
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04807541 | Medicaid | MS |
Other providers in Vicksburg, MS
- David Foster
- Rachel Foster
- Portia Fouche' Martin
- Brittany Fowler
- Walter Lee Frazier
- Freeman Physical Therapy
- Freeman Physical Therapy Inc.
- David Ron Freeman
- Valerie French
- Fresenius Medical Care Vicksburg Home, LLC
All providers in Vicksburg, 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 Sep 18, 2012. 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.