Organization
PAYLESS AT FRED'S INC
Active
Other names
Payless at Freds
Organization subpart
No
Provider details
NPI number
Authorized official
NICK W HOLLAND AUTHORIZED OFFICIAL (OWNER)
(256) 423-2680
Entity
Organization
Contact information
Practice address
29930 ARDMORE AVENUE, ARDMORE, AL 35739-7450
(256) 423-8989
(256) 423-8990
Mailing address
P.O. BOX 566, ARDMORE, TN 38449-0429
(256) 423-8969
(256) 423-8990
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
110617
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002271
—
AL
Enumeration date
05/26/2016
Last updated
05/26/2016
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