Freds Super Pharmacy Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

5301003028 Issued in MI

Legal business name

FREDS SUPER PHARMACY INC

Doing business as

Freds Pharmacy

Practice address

131 N Grand St
Schoolcraft, MI 49087

Phone

(269) 679-4061

Fax

(269) 679-4621

NPI assigned

Dec 16, 2005

Last updated

Aug 22, 2020By 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

Mr. Frederick William Nelson, RPH

Title

President Owner

Phone

(269) 649-0660

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Freds Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Freds Super Pharmacy Inc

  dba Freds Vicksburg Community Pharmacy

  • Community/Retail Pharmacy
  • Vicksburg, MI
  • NPI 1982680468

  O20060711000059

  Same enrollment

Practitioners 1

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.

• Elaine Ann Oestrike

  • Pharmacist
  • Vicksburg, MI
  • NPI 1447283403
  NPD

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902882426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 396",
            "address_2": "131 N GRAND ST",
            "city": "SCHOOLCRAFT",
            "state": "MI",
            "postal_code": "490870396",
            "telephone_number": "269-679-4061",
            "fax_number": "269-679-4621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 N GRAND ST",
            "city": "SCHOOLCRAFT",
            "state": "MI",
            "postal_code": "49087",
            "telephone_number": "269-679-4061",
            "fax_number": "269-679-4621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS SUPER PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "269-649-0660",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5301003028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2529293",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freds Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacist in Schoolcraft, MI
• Providers in Schoolcraft, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.