Freds Supermarket and Pharmacy of Three Rivers Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301001817 Issued in MI

Legal business name

FREDS SUPERMARKET AND PHARMACY OF THREE RIVERS INC

Doing business as

Freds Pharmacy

Practice address

808 W Michigan Ave
Freds Pharmacy
Three Rivers, MI 49093-3103

Phone

(269) 278-2355

Fax

(269) 279-9180

NPI assigned

Jan 3, 2006

Last updated

Feb 1, 2016By 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

Mrs. Sheroyl Marie Kirby, RPNNPI 1427153907

Title

Manager Stockholder

Phone

(269) 278-2355

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Freds Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 4

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.

• Sheroyl Marie Kirby, RPH

  • Pharmacist
  • Three Rivers, MI
  • NPI 1427153907
  NPD Authorized official
• Hagop P Ghazarian, DPM

  • Podiatrist
  • Mattawan, MI
  • NPI 1609820331
  NPD (past)
• Faith Kirby

  • Pharmacist
  • Three Rivers, MI
  • NPI 1760913925
  NPD (past)
• John Henry Pazynski

  • Pharmacist
  • Vicksburg, MI
  • NPI 1467041277
  NPD (past)

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1346228269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W MICHIGAN AVE",
            "address_2": "FREDS PHARMACY",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490933103",
            "telephone_number": "269-278-2355",
            "fax_number": "269-279-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 W MICHIGAN AVE",
            "address_2": "FREDS PHARMACY",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490933103",
            "telephone_number": "269-278-2355",
            "fax_number": "269-279-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS SUPERMARKET AND PHARMACY OF THREE RIVERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-03",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "KIRBY",
        "authorized_official_first_name": "SHEROYL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGER STOCKHOLDER",
        "authorized_official_telephone_number": "269-278-2355",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RPN"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301001817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2542203",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "2333780",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freds Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cameron Fischer
• Atty Jo Flood, LMSW
• Elaina Fogarty
• Natalie Joy Ford, PTA
• Frederick J Troyer (F. John Troyer, MA PCC LPC)
• Lacey B Freeman, A.P.R.N.
• Maddison R Frisbie, CNM
• Ashley Kaye Fritz, OD
• Michelle Froman
• Mary Fuehr, N.P.

• Community/Retail Pharmacy in Three Rivers, MI
• Providers in Three Rivers, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; 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.