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Provider Information for 1679593586


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FREDS STORES OF TENNESSEE INC

Other Names:  
Doing Business As: 
FREDS PHARMACY 1519

Organization Subpart: YES

NPI: 1679593586
Last Updated: 2008-01-11
Certification Date:

Details

NameValue
NPI1679593586
Enumeration Date2006-07-20
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Mr. RICKY CHAMBERS
Title: VP
Phone: 9012382477
Mailing Address 4300 NEW GETWELL RD
MEMPHIS, TN 38118-6801
United States

Phone: 901-238-2520 | Fax:901-365-9820
 
Primary Practice Address 156 WILFORD ASH PKWY
CLEVELAND, GA 30528
United States

Phone: 706-219-3733 | Fax:706-219-3739
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)1154385NCPDP
MEDICAIDGA929670152A
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyGAPHRE009048