# FREDS PHARMACY OF QUITMAN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982746327
- **Authorized official:** MS. JOYCE ROBERTSON (LICENSING SPECIALIST)
- **Authorized official phone:** (901) 238-2520

## Contact information

- **Practice address:** 125 MAIN ST, QUITMAN, MS 39355-2109
- **Practice address phone:** (601) 776-6282
- **Practice address fax:** (601) 776-6061
- **Mailing address:** 125 MAIN ST, QUITMAN, MS 39355-2109
- **Mailing address phone:** (601) 776-6282
- **Mailing address fax:** (601) 776-6061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 04508 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | 04508 | MS | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 01/05/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330475 | — | MS |
| 05 | — | 1982746327 | — | AL |
| 01 | — | 2521765 | NCPDP | — |