Organization
FREDS SUPER PHARMACY INC
Active
Other names
Freds Vicksburg Community Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE OESTRIKE (MANAGER/RPH)
(269) 649-0660
Entity
Organization
Contact information
Practice address
121 W PRAIRIE ST, VICKSBURG, MI 49097
(269) 649-0660
(269) 649-4755
Mailing address
PO BOX 80, 121 W PRAIRIE ST, VICKSBURG, MI 49097-0080
(269) 649-0660
(269) 649-4755
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301005983
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3045857
—
MI
Enumeration date
12/16/2005
Last updated
04/01/2015
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