# FREDS STORES OF TENNESSEE INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FREDS INC
- **Other names:** FREDS XPRESS 3926
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396762860
- **Legal business name:** FREDS INC
- **Authorized official:** RAHUL KULKARNI (SVP OF FINANCE)
- **Authorized official phone:** (800) 374-7417

## Contact information

- **Practice address:** 101 W SWEET POTATO ST, VARDAMAN, MS 38878-9433
- **Practice address phone:** (662) 682-7489
- **Practice address fax:** (662) 682-9132
- **Mailing address:** 6625 LENOX PARK BLVD., SUITE 200, MEMPHIS, TN 38115
- **Mailing address phone:** (901) 238-2520
- **Mailing address fax:** (901) 365-9820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 0403301FV | MS | — |
| 3336C0003X | Community/Retail Pharmacy | 0403301FV | MS | Yes |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 12/06/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0330357 | — | MS |
| 01 | — | 2519099 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |