Organization
FREDONIA PHARMACY INC
Active
Other names
FREDONIA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB EDWARDS (MANAGER)
(620) 378-4422
Entity
Organization
Contact information
Practice address
628 MADISON ST, FREDONIA, KS 66736-1338
(620) 378-4422
(620) 378-2586
Mailing address
628 MADISON ST, FREDONIA, KS 66736-1338
(620) 378-4422
(620) 378-2586
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
207947
KS
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100439810A
—
KS
01
—
2032337
PK
—
Enumeration date
08/31/2006
Last updated
01/16/2024
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