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General NPI Number Information
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NPI Number | 1730200114
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Entity Type | Organization
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Legal Business Name | FREDS XPRESS
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 FRONT ST
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-0818
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Country | US
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Telephone | 601-785-6812
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Fax | 601-785-4993
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Provider Business Mailing Address
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Address Line | PO BOX 818
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-0818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXEC VP
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Name | RICKY CHAMBERS
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Credential |
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 03081012
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License Number State | MS
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