Provider Information for 1679593586
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FREDS STORES OF TENNESSEE INC
Other Names:Doing Business As:FREDS PHARMACY 1519Organization Subpart: YES
NPI: 1679593586
Last Updated: 2008-01-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1679593586 | ||||||||||||
| Enumeration Date | 2006-07-20 | ||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||
| Status | Active | ||||||||||||
| 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 | ||||||||||||
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