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General NPI Number Information
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NPI Number | 1043242084
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Entity Type | Organization
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Legal Business Name | FREDS STORES OF TENNESSEE INC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 20917 HIGHWAY 61 N
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City | ROLLING FORK
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State | MS
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Zip | 39159-5027
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Country | US
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Telephone | 662-873-4723
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Fax | 662-873-4002
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Provider Business Mailing Address
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Address Line | 6625 LENOX PARK BLVD. SUITE 200
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City | MEMPHIS
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State | TN
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Zip | 38115
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Country | US
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Telephone | 901-238-2520
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Fax | 901-365-9820
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Authorized Official
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Title or Position | SVP OF FINANCE
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Name | RAHUL KULKARNI
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Credential |
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Telephone | 800-374-7417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0310201FR
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0310201FR
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License Number State | MS
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