Organization Active NPI

Freds Stores of Tennessee Inc

  • Community/Retail Pharmacy
  • Monroe, LA
National Provider Identifier
1790713758
Registry record updated Jan 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
35126 Issued in LA
Legal business name
FREDS STORES OF TENNESSEE INC
Doing business as
FREDS PHARMACY 2381
Practice address
2350 Sterlington Rd
Monroe, LA 71203-3044
Phone
(318) 340-0346
Fax
(318) 340-0863
NPI assigned
Jun 29, 2006
Organization subpart
Yes
Parent organization
FREDS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2008

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

Authorized official

Name
Ricky Chambers, PHARMD
Title
VP
Phone
(901) 238-2477

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 35126 LA
Community/Retail Pharmacy 3336C0003X 35126 LA Primary

Addresses

Primary practice location

2350 Sterlington Rd
Monroe, LA 71203-3044

Mailing address

4300 New Getwell Rd
Memphis, TN 38118-6801
Phone (901) 235-2520

Other identifiers 2

IdentifierTypeStateIssuer
1270865MedicaidLA
1931143OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • FREDS PHARMACY 2381 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": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200009600000",
    "number": "1790713758",
    "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": "901-235-2520",
            "fax_number": "901-365-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 STERLINGTON RD",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712033044",
            "telephone_number": "318-340-0346",
            "fax_number": "318-340-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDS STORES OF TENNESSEE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FREDS INC",
        "enumeration_date": "2006-06-29",
        "last_updated": "2008-01-11",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "RICKY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "901-238-2477",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "LA",
            "license": "35126",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "35126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1270865",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1931143",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FREDS PHARMACY 2381",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; 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.