Organization
FREDS PHARMACY OF QUITMAN LLC
Active
Other names
FREDS PHARMACY 7681
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICKY CHAMBERS PHARMD (VP)
(901) 238-2477
Entity
Organization
Contact information
Practice address
626 22ND AVE S, MERIDIAN, MS 39301-6120
(601) 701-0019
(601) 693-2693
Mailing address
626 22ND AVE S, MERIDIAN, MS 39301-6120
(601) 701-0019
(601) 693-2693
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
07342
MS
3336C0003X
Community/Retail Pharmacy
Primary
07342
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00701261
—
MS
01
—
2586812
NCPDP
—
Enumeration date
04/24/2007
Last updated
09/18/2012
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