Organization
FREDS STORES OF TENNESSEE INC
Active
Parent organization
FREDS INC
Other names
Freds Pharmacy 2784
Organization subpart
Yes
Provider details
NPI number
Legal business name
FREDS INC
Authorized official
RICKY CHAMBERS PHARMD (VP)
(901) 238-2477
Entity
Organization
Contact information
Practice address
1876 E BLACKSTOCK RD, ROEBUCK, SC 29376-2700
(864) 574-8323
(864) 574-9147
Mailing address
4300 NEW GETWELL RD, MEMPHIS, TN 38118-6801
(901) 238-2520
(901) 365-9820
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
10550
SC
3336C0003X
Community/Retail Pharmacy
Primary
10550
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4229096
NCPDP
—
05
—
71055D
—
SC
01
—
DE3393
MEDICAID DME
SC
Enumeration date
07/30/2009
Last updated
08/09/2011
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