Freds Stores of Tennessee Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

FREDS STORES OF TENNESSEE INC

Practice address

6311 La Highway 1 S
Brusly, LA 70719-2416

Phone

(227) 749-5991

Fax

(227) 749-5292

NPI assigned

Oct 22, 2013

Organization subpart

Yes

Parent organization

FREDS INCAs reported in NPPES

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

Authorized official

Name

Rick Chambers

Title

Evp

Phone

(901) 238-2520

Specialties & licenses 1

Addresses

Other names 1

• Freds Pharmacy 2569 Doing business as

Locations

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413244800000",
    "number": "1235567728",
    "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": "6311 LA HIGHWAY 1 S",
            "city": "BRUSLY",
            "state": "LA",
            "postal_code": "707192416",
            "telephone_number": "227-749-5991",
            "fax_number": "227-749-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS STORES OF TENNESSEE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS INC",
        "enumeration_date": "2013-10-22",
        "last_updated": "2014-10-14",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "901-238-2520"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freds Pharmacy 2569",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donald H. De Latin, D.D.S.
• Wendy R Devall
• Dynamic Therapy, LLC
• Dynamic Therapy, LLC
• Tonnisha Ellis
• Ariel Nashandra Gilbert-Pate, BSN RN
• Eboni Harris, PHARMD
• Brian P Higgins, M.D.
• Jay'la Holliday
• Jessica Theriot Horner, DPT

• All providers in Brusly, LA
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; 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.