Provider Demographics
NPI:1225056567
Name:FRED C SANDLIN JR
Entity Type:Organization
Organization Name:FRED C SANDLIN JR
Other - Org Name:FREDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANDLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RHP
Authorized Official - Phone:205-921-3193
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-0036
Mailing Address - Country:US
Mailing Address - Phone:205-921-3193
Mailing Address - Fax:205-921-2576
Practice Address - Street 1:797 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-4737
Practice Address - Country:US
Practice Address - Phone:205-921-3193
Practice Address - Fax:205-921-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL104160251E00000X, 332B00000X, 332BP3500X, 332BX2000X, 333600000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003563Medicaid
AL510-68006OtherBCBS HIT
AL000051121Medicaid
AL009922585Medicaid
MS0107361OtherBCBS MS
1537359OtherUMWA
MS00330656Medicaid
MS00440633Medicaid
AL510-51121OtherBCBS
MS00440633Medicaid
AL009922585Medicaid
AL4308840001Medicare NSC