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Organization
FREDS PHARMACY OF QUITMAN
Active
Organization
FREDS PHARMACY OF QUITMAN
Active
Other names
FRED'S PHARMACY 7601
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICKY CHAMBERS PHARMD (VP)
(901) 238-2477
Entity
Organization
Contact information
Practice address
1098 MARTIN LUTHER KING DR, MARKS, MS 38646-1825
(662) 326-9272
(662) 326-5268
Mailing address
1098 MARTIN LUTHER KING DR, MARKS, MS 38646-1825
(662) 326-9272
(662) 326-5268
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
06997011
MS
3336C0003X
Community/Retail Pharmacy
Primary
06997011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03407032
—
MS
01
—
2586569
NCPDP
—
Enumeration date
07/20/2006
Last updated
11/12/2014
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