Freds Stores of Tennessee Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

FREDS STORES OF TENNESSEE INC.

Practice address

303 N Hood St
Lake Providence, LA 71254-2141

Phone

(318) 559-2433

NPI assigned

May 13, 2013

Organization subpart

Yes

Parent organization

FREDS INC.As reported in NPPES

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

Authorized official

Name

Rahul Kulkarni

Title

SVP of Finance

Phone

(800) 374-7417

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Freds Pharmacy 3958 Doing business as

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

{
    "created_epoch": "1368403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1306282827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6625 LENOX PARK BLVD.",
            "address_2": "SUITE 200",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38115",
            "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": "303 N HOOD ST",
            "city": "LAKE PROVIDENCE",
            "state": "LA",
            "postal_code": "712542141",
            "telephone_number": "318-559-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS STORES OF TENNESSEE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS INC.",
        "enumeration_date": "2013-05-13",
        "last_updated": "2019-12-06",
        "status": "A",
        "authorized_official_last_name": "KULKARNI",
        "authorized_official_first_name": "RAHUL",
        "authorized_official_title_or_position": "SVP OF FINANCE",
        "authorized_official_telephone_number": "800-374-7417"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2202162",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "212141407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freds Pharmacy 3958",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Freds Pharmacy 3958",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• George Fakhre
• Ann Sullivan Fautheree, LPC
• Sade' Finley
• Savannah Fortenberry, APRN, FNP-C
• Fred'S Pharmacy #3958
• Catina Freeman
• Heather George, BA
• Sharolyn Gibson
• Tonya Denise Gordon
• H & H Transportation LLC

• Community/Retail Pharmacy in Lake Providence, LA
• Providers in Lake Providence, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.