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General NPI Number Information
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NPI Number | 1215957428
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Entity Type | Organization
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Legal Business Name | FREDS PHARMACY OF QUITMAN
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 1098 MARTIN LUTHER KING DR
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City | MARKS
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State | MS
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Zip | 38646-1825
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Country | US
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Telephone | 662-326-9272
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Fax | 662-326-5268
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Provider Business Mailing Address
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Address Line | 1098 MARTIN LUTHER KING DR
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City | MARKS
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State | MS
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Zip | 38646-1825
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Country | US
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Telephone | 662-326-9272
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Fax | 662-326-5268
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Authorized Official
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Title or Position | VP
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Name | MR. RICKY CHAMBERS
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Credential | PHARMD
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Telephone | 901-238-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 06997011
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 06997011
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License Number State | MS
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