Provider Demographics
NPI:1427807965
Name:FREDS PHARMACY LLC
Entity type:Organization
Organization Name:FREDS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-642-3733
Mailing Address - Street 1:75 QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-1519
Mailing Address - Country:US
Mailing Address - Phone:518-642-3733
Mailing Address - Fax:518-642-3737
Practice Address - Street 1:75 QUAKER ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1519
Practice Address - Country:US
Practice Address - Phone:518-642-3733
Practice Address - Fax:518-642-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy