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Contact Information

FREDS SUPER PHARMACY INC
121 W PRAIRIE ST
VICKSBURG, MI49097
 Phone: 269-649-0660
 Fax: 269-649-4755
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for FREDS SUPER PHARMACY INC

NPI Number 1982680468
LBN Legal business name FREDS SUPER PHARMACY INC
Authorized official ELAINE OESTRIKE - (MANAGER/RPH)
Entity Organization
Organization subpart 1 No
Enumeration date 12/16/2005
Last updated 04/01/2015 - About 11 years ago
Identifiers
MI License # 5301005983
MI Medicaid 3045857
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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