NPIMap

Organization Active NPI

Freds Pharmacy of Quitman LLC

  • Community/Retail Pharmacy
  • Vicksburg, MS
National Provider Identifier
1306102470
Registry record updated Sep 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 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
Last updated
Sep 18, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
FREDS PHARMACY OF QUITMAN LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2012

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

Authorized official

Name
Rick Chambers
Title
Vice President
Phone
(901) 238-2477

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1123 Washington St
Vicksburg, MS 39183-2959

Mailing address

PO Box 5105
Meridian, MS 39302-5105
Phone (601) 693-2655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
The Pharmacy of Quitman

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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

125 Main St
Quitman, MS 39355
Phone (601) 776-6282

2431 Clay St
Vicksburg, MS 39183
Phone (601) 636-2756

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1306102470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5105",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393025105",
            "telephone_number": "601-693-2655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 WASHINGTON ST",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832959",
            "telephone_number": "601-636-2756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS PHARMACY OF QUITMAN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS PHARMACY OF QUITMAN LLC",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "901-238-2477"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.