Organization
FREDS STORES OF TENNESSEE INC
Active
Other names
FREDS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX KNIGHT (DIR OF THIRD PARTY OPERATIONS)
(901) 238-3625
Entity
Organization
Contact information
Practice address
1302 HIGHWAY 64 E, AUGUSTA, AR 72006-9411
(870) 347-5004
(870) 347-5014
Mailing address
1302 HIGHWAY 64 E, AUGUSTA, AR 72006-9411
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20520
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0422155
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/07/2006
Last updated
07/17/2007
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