Freds Stores of Tennessee Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

29101FL Issued in MS

Legal business name

FREDS STORES OF TENNESSEE INC

Doing business as

Freds Pharmacy 2176

Practice address

301 Yazoo St
Lexington, MS 39095-3644

Phone

(662) 834-3378

Fax

(662) 834-3395

NPI assigned

Jul 7, 2006

Last updated

Dec 6, 2019By the provider in NPPES

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 2

Other names 1

• FREDS PHARMACY 2176 Doing business as

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": "1316979354",
    "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": "301 YAZOO ST",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390953644",
            "telephone_number": "662-834-3378",
            "fax_number": "662-834-3395"
        }
    ],
    "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": "MS",
            "license": "29101FL",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "29101FL",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2518035",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330144",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FREDS PHARMACY 2176",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FREDS PHARMACY 2176",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Randi Hutchinson Edwards, MS, CCC-SLP
• Melanie Eiland, NP
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• Greenwood Leflore Hospital (Lexington Primary Care Clinic)
• Lily Francesca Guastella, MD
• Heather Killebrew Tutor, DMD, PA
• Henrich Drug Store, Inc

• Community/Retail Pharmacy in Lexington, MS
• Providers in Lexington, MS by specialty
• Community/Retail Pharmacy in Mississippi

• 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.