Organization
FREDS PHARMACY OF QUITMAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOYCE ROBERTSON (LICENSING SPECIALIST)
(901) 238-2520
Entity
Organization
Contact information
Practice address
125 MAIN ST, QUITMAN, MS 39355-2109
(601) 776-6282
(601) 776-6061
Mailing address
125 MAIN ST, QUITMAN, MS 39355-2109
(601) 776-6282
(601) 776-6061
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
04508
MS
3336C0003X
Community/Retail Pharmacy
Primary
04508
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330475
—
MS
05
—
1982746327
—
AL
01
—
2521765
NCPDP
—
Enumeration date
02/13/2007
Last updated
01/05/2018
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