Healthcare Provider Details

I. General information

NPI: 1609808641
Provider Name (Legal Business Name): FREDS STORES OF TENNESSEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E SHILOH RD
CORINTH MS
38834-3727
US

IV. Provider business mailing address

2040 E SHILOH RD
CORINTH MS
38834-3727
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-6355
  • Fax: 662-287-0347
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1929PFC
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALEX KNIGHT
Title or Position: DIR OF THIRD PARTY OPERATIONS
Credential:
Phone: 901-238-3625