NPIMap

Organization Active NPI

Freds Stores of Tennessee Inc

Doing business as Freds Pharmacy 1054

  • Community/Retail Pharmacy
  • Rome, GA
National Provider Identifier
1194887372
Registry record updated Jan 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHR009104 Issued in GA
Legal business name
FREDS STORES OF TENNESSEE INC
Doing business as
Freds Pharmacy 1054
Practice address
4111 Martha Berry Hwy NW
Rome, GA 30165-7705
Phone
(706) 378-8073
Fax
(706) 378-8076
NPI assigned
Dec 14, 2006
Last updated
Jan 11, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
FREDS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ricky Chambers, PHARMD
Title
VP
Phone
(901) 238-2477

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHR009104 GA Primary

Addresses

Primary practice location

4111 Martha Berry Hwy NW
Rome, GA 30165-7705

Mailing address

4300 New Getwell Rd
Memphis, TN 38118-6801
Phone (901) 238-2520

Other identifiers 1

IdentifierTypeStateIssuer
1154905OtherNCPDP

Other names 1

  • FREDS PHARMACY 1054 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Freds Pharmacy25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

4111 Martha Berry Hwy NW
Rome, GA 30165
Phone (706) 378-8073

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200009600000",
    "number": "1194887372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 NEW GETWELL RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381186801",
            "telephone_number": "901-238-2520",
            "fax_number": "901-365-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 MARTHA BERRY HWY NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301657705",
            "telephone_number": "706-378-8073",
            "fax_number": "706-378-8076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS STORES OF TENNESSEE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS INC",
        "enumeration_date": "2006-12-14",
        "last_updated": "2008-01-11",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "RICKY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "901-238-2477",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHR009104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1154905",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FREDS PHARMACY 1054",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rome, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.