Active NPI
Freds Pharmacy of Quitman
Doing business as Freds Pharmacy 7141
- Community/Retail Pharmacy
- Charleston, MS
National Provider Identifier
1659771665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- FREDS PHARMACY OF QUITMAN
- Doing business as
- Freds Pharmacy 7141
- Practice address
- 304 W Main St
Charleston, MS 38921-2231 - Phone
- (662) 647-5541
- NPI assigned
- Aug 27, 2014
- Last updated
- Jan 5, 2015
- Organization subpart
- Yes
- Parent organization
- FREDS PHARMACY OF QUITMAN LLC
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
304 W Main St
Charleston, MS 38921-2231
Mailing address
PO Box 5105
Meridian, MS 39302-5105
Phone (601) 693-2655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4485702 | Medicaid | MS |
Other names 1
- Freds Pharmacy 7141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| 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 |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Fred's Pharmacy 7601
- Community/Retail Pharmacy
- Marks, MS
- NPI 1215957428
O20150218002190
-
- Community/Retail Pharmacy
- Vicksburg, MS
- NPI 1306102470
O20150218002190
-
dba Freds Pharmacy 7681
- Community/Retail Pharmacy
- Meridian, MS
- NPI 1528287042
O20150218002190
National Provider Directory
National Provider Directory- Part of
- Freds Pharmacy of Quitman LLC
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Freds Pharmacy 7681
- Community/Retail Pharmacy
- Meridian, MS
- NPI 1528287042
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409097600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1420416000000",
"number": "1659771665",
"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": "304 W MAIN ST",
"city": "CHARLESTON",
"state": "MS",
"postal_code": "389212231",
"telephone_number": "662-647-5541"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FREDS PHARMACY OF QUITMAN",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FREDS PHARMACY OF QUITMAN LLC",
"enumeration_date": "2014-08-27",
"last_updated": "2015-01-05",
"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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4485702",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Freds Pharmacy 7141",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Charleston, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; 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.