Organization
FREDS STORES OF TENNESSEE INC
Active
Parent organization
FREDS INC
Other names
FREDS PHARMACY 1201
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
1212 MILITARY RD, BENTON, AR 72015-2908
(501) 778-2036
(501) 778-6899
Mailing address
4300 NEW GETWELL RD, MEMPHIS, TN 38118-6801
(901) 238-2520
(901) 365-9820
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
417255
AR
3336C0003X
Community/Retail Pharmacy
Primary
417255
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0417255
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
120515407
—
AR
01
—
156772716
DME
AR
Enumeration date
06/29/2006
Last updated
01/04/2010
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