Organization
FREDS STORES OF TENNESSEE INC
Active
Parent organization
FREDS INC
Other names
FREDS PHARMACY 1431
Organization subpart
Yes
Provider details
NPI number
Legal business name
FREDS INC
Authorized official
RICK CHAMBERS PHARMD (VP)
(901) 238-2477
Entity
Organization
Contact information
Practice address
340 VIRGINIA AVE, DALEVILLE, AL 36322-2330
(334) 503-9918
(334) 503-9238
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
111934
AL
3336C0003X
Community/Retail Pharmacy
Primary
111934
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0130714
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
100003248
—
AL
01
—
141962
MEDICAID DME
AL
Enumeration date
07/07/2006
Last updated
12/12/2012
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