Organization
FREDS OF DONIPHAN INC
Active
Other names
Super Saver Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CLAYTON JAMISON (OWNER,AO)
(573) 996-5220
Entity
Organization
Contact information
Practice address
100 H&S DRIVE, DONIPHAN, MO 63935
(573) 996-5220
(573) 996-3790
Mailing address
PO BOX 337, DONIPHAN, MO 63935-0337
(573) 996-5220
(573) 996-3790
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2018006081
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2173109
PK
—
Enumeration date
11/08/2017
Last updated
07/08/2019
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