Freds Stores of Tennessee Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

FREDS STORES OF TENNESSEE INC

Doing business as

Freds Pharmacy 3514

Practice address

219 State St
McComb, MS 39648-3938

Phone

(601) 684-2621

NPI assigned

Jul 31, 2012

Last updated

Jan 7, 2013By 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

Rick Chambers

Title

Vice President

Phone

(901) 238-2477

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Freds Pharmacy 3514 Doing business as

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357516800000",
    "number": "1386990059",
    "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": "219 STATE ST",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483938",
            "telephone_number": "601-684-2621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS STORES OF TENNESSEE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS INC",
        "enumeration_date": "2012-07-31",
        "last_updated": "2013-01-07",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "901-238-2477"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01373264",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freds Pharmacy 3514",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cameron Givens Foret
• Lasontiga Forrest
• Christina Rayburn Fortenberry, CRNA
• Hugh Russell Fortenberry Jr., CRNA
• Freds Stores of Tennessee Inc (Fred's Pharmacy #3587)
• Marc Freeman, MD
• Nin-Sarai Shirley Freeman
• Bryan G Frentz, M.D.
• Fresenius Medical Care East McComb Dialysis, LLC (Fresenius Kidney Care East McComb)
• Jane C Funderburg, LCSW

• Community/Retail Pharmacy in McComb, MS
• Providers in McComb, 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 Jan 7, 2013; 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.