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NPI Code Detail

MEDICARE: FREDS STORES OF TENNESSEE INC

MEDICARE: FREDS STORES OF TENNESSEE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295083863
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREDS STORES OF TENNESSEE INC
Provider Business Mailing Address
First Line : 4300 NEW GETWELL RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38118-6801
Country : US
Telephone Number : 901-238-2520
Fax Number : 901-365-9820
Provider Business Practice Location Address
First Line : 224 S THREE NOTCH ST
Second Line :
City : ANDALUSIA
State : AL
Zip : 36420-3710
Country : US
Telephone Number : 334-222-1131
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : RICK CHAMBERS
Credential :
Telephone Number : 901-238-2477
Provider Enumeration Date : 08/29/2012
Last Update Date : 12/26/2012

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Directions to “FREDS STORES OF TENNESSEE INC ” Practice Location

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