MEDICARE: FREDONIA PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336S0011X	Specialty Pharmacy
5	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1366200586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDONIA PHARMACY INC

Provider Business Mailing Address
First Line	:	628 MADISON ST
Second Line	:
City	:	FREDONIA
State	:	KS
Zip	:	66736-1338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 MADISON ST
Second Line	:
City	:	FREDONIA
State	:	KS
Zip	:	66736-1338
Country	:	US
Telephone Number	:	620-378-4422
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	JACOB EDWARDS
Credential	:
Telephone Number	:	620-378-4422

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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Directions to “FREDONIA PHARMACY INC ” Practice Location

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