# FREDS PHARMACY OF QUITMAN LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FREDS PHARMACY OF QUITMAN LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1306102470
- **Legal business name:** FREDS PHARMACY OF QUITMAN LLC
- **Authorized official:** RICK CHAMBERS (VICE PRESIDENT)
- **Authorized official phone:** (901) 238-2477

## Contact information

- **Practice address:** 1123 WASHINGTON ST, VICKSBURG, MS 39183-2959
- **Practice address phone:** (601) 636-2756
- **Mailing address:** PO BOX 5105, MERIDIAN, MS 39302-5105
- **Mailing address phone:** (601) 693-2655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/03/2012
- **Last updated:** 09/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04807541 | — | MS |