Organization
FREDS STORES OF TENNESSEE INC
Active
Parent organization
FREDS INC
Other names
FREDS PHARMACY 1086
Organization subpart
Yes
Provider details
NPI number
Legal business name
FREDS INC
Authorized official
RAHUL KULKARNI (SVP OF FINANCE)
(800) 374-7417
Entity
Organization
Contact information
Practice address
901 W DEWITT HENRY DR, BEEBE, AR 72012-2105
(501) 882-5402
(501) 882-0303
Mailing address
6625 LENOX PARK BLVD., SUITE 200, MEMPHIS, TN 38115
(901) 238-2520
(901) 365-9820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
420232
AR
3336C0003X
Community/Retail Pharmacy
Primary
420232
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0421088
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
140230407
—
AR
01
—
156771716
DME
AR
Enumeration date
07/07/2006
Last updated
12/06/2019
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