Healthcare Provider Details

I. General information

NPI: 1356373294
Provider Name (Legal Business Name): FREDS OF PARSONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 TENNESSEE AVE N
PARSONS TN
38363-2616
US

IV. Provider business mailing address

501 TENNESSEE AVE N
PARSONS TN
38363-2616
US

V. Phone/Fax

Practice location:
  • Phone: 731-847-3851
  • Fax: 731-847-2216
Mailing address:
  • Phone: 731-847-3851
  • Fax: 731-847-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberC2974
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberC2974
License Number StateTN

VIII. Authorized Official

Name: RICKY CHAMBERS
Title or Position: VP
Credential: PHARMD
Phone: 901-238-2477