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General NPI Number Information
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NPI Number | 1477585412
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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 | 11/05/2012
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Provider Practice Location Address
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Address Line | 1021 US HIGHWAY 45 N
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City | ELDORADO
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State | IL
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Zip | 62930-3767
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Country | US
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Telephone | 618-273-3874
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Fax | 618-273-3843
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Provider Business Mailing Address
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Address Line | 4300 NEW GETWELL RD
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City | MEMPHIS
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State | TN
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Zip | 38118-6801
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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 | VP
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Name | RICKY CHAMBERS
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Credential | PHARMD
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Telephone | 901-238-2477
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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 | 54014867
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License Number State | IL
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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 | 54014867
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License Number State | IL
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