NPIMap

Organization Active NPI

Freds Pharmacy of Quitman

  • Community/Retail Pharmacy
  • Quitman, MS
National Provider Identifier
1982746327
Registry record updated Jan 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
04508 Issued in MS
Legal business name
FREDS PHARMACY OF QUITMAN
Practice address
125 Main St
Quitman, MS 39355-2109
Phone
(601) 776-6282
Fax
(601) 776-6061
NPI assigned
Feb 13, 2007
Last updated
Jan 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2018

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

Authorized official

Name
Ms. Joyce Robertson
Title
Licensing Specialist
Phone
(901) 238-2520

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 04508 MS
Community/Retail Pharmacy 3336C0003X 04508 MS Primary

Addresses

Primary practice location

125 Main St
Quitman, MS 39355-2109

Mailing address

125 Main St
Quitman, MS 39355-2109
Phone (601) 776-6282

Other identifiers 3

IdentifierTypeStateIssuer
1982746327MedicaidAL
00330475MedicaidMS
2521765OtherNCPDP

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

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515110400000",
    "number": "1982746327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 MAIN ST",
            "city": "QUITMAN",
            "state": "MS",
            "postal_code": "393552109",
            "telephone_number": "601-776-6282",
            "fax_number": "601-776-6061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 MAIN ST",
            "city": "QUITMAN",
            "state": "MS",
            "postal_code": "393552109",
            "telephone_number": "601-776-6282",
            "fax_number": "601-776-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS PHARMACY OF QUITMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2018-01-05",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "LICENSING SPECIALIST",
        "authorized_official_telephone_number": "901-238-2520",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MS",
            "license": "04508",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "04508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982746327",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330475",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2521765",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quitman, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2018; 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.