FREDS SUPER PHARMACY INC (NPI# 1982680468) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982680468 |
| Entity Type | Organization |
| Organization Name | FREDS SUPER PHARMACY INC |
| Other Organization Name | FREDS VICKSBURG COMMUNITY PHARMACY |
| Practice Address |
121 W Prairie St Vicksburg MI 49097 |
| Mailing Address |
Po Box 80 121 W Prairie St Vicksburg MI 49097-0080 |
| Practice Telephone | 2696490660 |
| Practice Fax Number | 2696494755 |
| Mailing Telephone | 2696490660 |
| Mailing Fax Number | 2696494755 |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2015-04-01 |
| Authorized Official Name | ELAINE OESTRIKE (MANAGER/RPH) |
| Authorized Official Telephone | 2696490660 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
5301005983 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 3045857 | 05 |
| Other Name | Type Code |
|---|---|
| Freds Vicksburg Community Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902882426 | Freds Super Pharmacy Inc | Pharmacist | 131 N Grand St, Schoolcraft, MI 49087 | 2005-12-16 |
| Street Address |
121 W PRAIRIE ST |
| City | VICKSBURG |
| State | MI |
| Zip Code | 49097 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447283403 | Elaine Ann Oestrike | Pharmacist | 121 W Prairie St, Vicksburg, MI 49097-1258 | 2006-07-09 |
| 1548298185 | Jodee Ann Nelson | Pharmacy Technician | 121 W Prairie St, Vicksburg, MI 49097-1258 | 2006-06-30 |
| 1174551998 | Frederick William Nelson | Pharmacist | 121 W Prairie St, Vicksburg, MI 49097-1258 | 2006-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912132168 | Jo Lynne Kirchhoff | Pharmacist | 110 S. Main Streets, Vicksburg, MI 49097 | 2009-05-18 |
| 1558429605 | Ellen Marie Tavarone | Dentist | 602 West Prairie St, Vicksburg, MI 49097 | 2006-12-04 |
| 1598875601 | Robert L Dornbos Dds PC | Dentist | 102 S Main, Vicksburg, MI 49097 | 2006-08-30 |
| 1477853422 | South County Home Health Providers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 115 N 3rd St, Vicksburg, MI 49097-1017 | 2010-10-25 |
| 1023214921 | Aaron C Ford | Dentist | 602 W Prairie St, Vicksburg, MI 49097-1178 | 2007-06-26 |
| 1154573392 | Family & Children Services, Inc. | Clinic/Center | 101 S Main St, Vicksburg, MI 49097-1210 | 2008-10-21 |
| 1144756610 | Pamela Hendershot | Pharmacist | 110 S Main St, Vicksburg, MI 49097-1211 | 2017-05-03 |
| 1598990525 | Kelly Ann Soekarmoen | Pharmacist | 110 S Main St, Vicksburg, MI 49097-1211 | 2009-05-19 |
| 1184670085 | Hill's Pharmacy of Vicksburg, Inc. | Pharmacy | 110 S Main St, Vicksburg, MI 49097-1211 | 2006-05-25 |
| 1982684916 | Robert L Dornbos | Dentist | 102 S Main St, Vicksburg, MI 49097-1211 | 2006-01-17 |
| Find all providers in zip 49097 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306102470 | Freds Pharmacy of Quitman LLC | Pharmacy | 1123 Washington St, Vicksburg, MS 39183-2959 | 2012-04-03 |
| 1740412964 | Battlefield Express Drugs Incorporated | Pharmacy | 2080 S Frontage Rd, Suite 101, Vicksburg, MS 39180-5328 | 2009-08-21 |
| 1922258730 | Battlefield Clinic Drugs | Pharmacy | 2080 S Frontage Rd, Ste N, Vicksburg, MS 39180-5328 | 2008-09-29 |
| 1184670085 | Hill's Pharmacy of Vicksburg, Inc. | Pharmacy | 110 S Main St, Vicksburg, MI 49097-1211 | 2006-05-25 |
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| 1225645781 | Good Choice Pharmacy LLC | Pharmacy | 6750 E 10 Mile Rd, Center Line, MI 48015-1166 | 2020-09-29 |
| 1487269122 | Canfield Pharmacy LLC | Pharmacy | 4673 Conner St, Detroit, MI 48215-2028 | 2020-09-10 |
| 1851905707 | Skidway Pharmacy LLC | Pharmacy | 1830 Greenwood Rd, Prescott, MI 48756-8627 | 2020-09-08 |
| 1023621190 | Azam Mohsen Mesleh | Pharmacy | 6811 Theisen St, Dearborn, MI 48126-1927 | 2020-08-28 |
| 1821606310 | S&k Pharmacy Inc. | Pharmacy | 1916 Davison Rd, Flint, MI 48506-4423 | 2020-07-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.