Freds Stores of Tennessee Inc
Organization Active NPI Community/Retail Pharmacy · Brookesville, MS
NPI 1104843671 · NPPES record last updated Dec 4, 2007
Key facts
- NPI
- 1104843671
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 5847012 (MS)
- Legal business name
- FREDS STORES OF TENNESSEE INC
- Practice address
- 25 Main Street
Brookesville, MS 39739 - Phone
- (662) 738-5878
- Fax
- (662) 738-4888
- NPI assigned
- Jul 17, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- FREDS INC
Authorized official
- Name
- Ricky Chambers, PHARMD
- Title
- VP
- Phone
- (901) 238-2477
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Freds Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 5847012 | MS | |
| Community/Retail Pharmacy | 3336C0003X | 5847012 | MS | Yes |
Addresses
Primary practice location
25 Main Street
Brookesville, MS 39739
Mailing address
4300 New Getwell Rd
Memphis, TN 38118-6801
Phone (901) 238-2520
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2521359 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 6301716 | Medicaid | MS |
Other names
- FREDS XPRESS 3516
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.