NPIMap

Organization Active NPI

Freds Stores of Tennessee Inc

  • Community/Retail Pharmacy
  • Vardaman, MS
National Provider Identifier
1396762860
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0403301FV Issued in MS
Legal business name
FREDS STORES OF TENNESSEE INC
Doing business as
FREDS XPRESS 3926
Practice address
101 W Sweet Potato St
Vardaman, MS 38878-9433
Phone
(662) 682-7489
Fax
(662) 682-9132
NPI assigned
Jul 17, 2006
Organization subpart
Yes
Parent organization
FREDS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 0403301FV MS
Community/Retail Pharmacy 3336C0003X 0403301FV MS Primary

Addresses

Primary practice location

101 W Sweet Potato St
Vardaman, MS 38878-9433

Mailing address

6625 Lenox Park Blvd.
Suite 200
Memphis, TN 38115
Phone (901) 238-2520

Other identifiers 2

IdentifierTypeStateIssuer
2519099OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0330357MedicaidMS

Other names 1

  • FREDS XPRESS 3926 Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1396762860",
    "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": "101 W SWEET POTATO ST",
            "city": "VARDAMAN",
            "state": "MS",
            "postal_code": "388789433",
            "telephone_number": "662-682-7489",
            "fax_number": "662-682-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS STORES OF TENNESSEE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS INC",
        "enumeration_date": "2006-07-17",
        "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": "0403301FV",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "0403301FV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2519099",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330357",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FREDS XPRESS 3926",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FREDS XPRESS 3926",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vardaman, MS

Sources for this page

  • 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.