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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