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General NPI Number Information
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NPI Number | 1962434993
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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 | 01/04/2010
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Provider Practice Location Address
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Address Line | 2750 PINE ST UNIT 1
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City | ARKADELPHIA
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State | AR
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Zip | 71923-4206
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Country | US
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Telephone | 870-246-6751
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Fax | 870-246-9568
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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 | 417902
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License Number State | AR
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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 | 417902
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License Number State | AR
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