Provider Demographics
NPI:1043680887
Name:FRED'S INC
Entity type:Organization
Organization Name:FRED'S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-374-7417
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441-0070
Mailing Address - Country:US
Mailing Address - Phone:225-222-6125
Mailing Address - Fax:225-222-6197
Practice Address - Street 1:6216 HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:LA
Practice Address - Zip Code:70441
Practice Address - Country:US
Practice Address - Phone:225-222-6125
Practice Address - Fax:225-222-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1936472Medicaid