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FREDS SUPER PHARMACY INC NPI 1982680468


NPI Information

NPI: 1982680468
Provider Name: FREDS SUPER PHARMACY INC

Doing Business As: FREDS VICKSBURG COMMUNITY PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
121 W PRAIRIE ST
VICKSBURG, MI
ZIP 49097
Phone: (269) 649-0660
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FREDS SUPER PHARMACY INC is a community/retail pharmacy pharmacy in Vicksburg, MI. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. FREDS SUPER PHARMACY INC NPI is 1982680468. The provider is registered as an organization entity type.
The provider Is Doing Business As Freds Vicksburg Community Pharmacy.

The provider's business location address is:

121 W PRAIRIE ST
VICKSBURG, MI
ZIP 49097
Phone: (269) 649-0660
Fax: (269) 649-4755

The provider's authorized official is Elaine Oestrike .
The authorized official title is Manager/rph and has the following contact phone number (269) 649-0660.

The enumeration date for this NPI number is 12/16/2005 and was last updated on 4/1/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
13336C0003XPharmacyCommunity/Retail Pharmacy5301005983MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13045857MEDICAIDMICHIGAN
20755530002MEDICARE ID-TYPE UNSPECIFIEDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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