MEDICARE: FREDONIA PHARMACY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	207947	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2032337	OTHER		PK

General Provider Information

NPI Number	:	1942312897
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	:	620-378-4422
Fax Number	:	620-378-2586

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	:	620-378-2586

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/16/2024

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Directions to “FREDONIA PHARMACY INC ” Practice Location

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