Freds Stores of Tennessee Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

419526 Issued in AR

Legal business name

FREDS STORES OF TENNESSEE INC

Practice address

2 Forest Park Dr
Holiday Island, AR 72631-9229

Phone

(479) 253-7062

Fax

(479) 253-7509

NPI assigned

Jul 7, 2006

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

Rahul Kulkarni

Title

SVP of Finance

Phone

(800) 374-7417

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• FREDS PHARMACY 1881 Doing business as

Locations

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1316979347",
    "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": "2 FOREST PARK DR",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "726319229",
            "telephone_number": "479-253-7062",
            "fax_number": "479-253-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS STORES OF TENNESSEE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS INC",
        "enumeration_date": "2006-07-07",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AR",
            "license": "419526",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "419526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "179664716",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0419526",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316979347",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130603407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FREDS PHARMACY 1881",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FREDS PHARMACY 1881",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sidney Carnes
• Sarah Davis
• Rene Charles Duffourc III, M.D.
• Eureka Springs Hospital
• Eureka Springs Hospital
• Carolyn S Gentry, RN
• Brooke Aubrey Granger, COTA
• Sterling Granger, PTA
• Green Acre Lodge Inc.
• Jharry Ann Santos Gumabon, COTA/L

• Community/Retail Pharmacy in Holiday Island, AR
• Providers in Holiday Island, AR by specialty
• Community/Retail Pharmacy in Arkansas

• 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.