MEDICARE: FREDS STORES OF TENNESSEE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	711227	SC
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700188737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDS STORES OF TENNESSEE INC

Provider Business Mailing Address
First Line	:	4300 NEW GETWELL RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38118-6801
Country	:	US
Telephone Number	:	901-238-2520
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W MAIN ST
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-2038
Country	:	US
Telephone Number	:	864-859-4015
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	DR. RICKY CHAMBERS
Credential	:	PHARMD
Telephone Number	:	901-238-2477

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	08/09/2011

Similar Medicare Providers

1942164231 — WILL FORTNER
Practice Location Address:

101 W MAIN ST
EASLEY, SC
29640-2038

Practice Phone: 864-307-9198
Practice Fax:

1700740990 — MICHELLE LOGAN
Practice Location Address:

101 W MAIN ST
EASLEY, SC
29640-2038

Practice Phone: 864-307-9198
Practice Fax:

1861466807 — MMRX OF EASLEY INC
Practice Location Address:

101 W MAIN ST
EASLEY, SC
29640-2038

Practice Phone: 864-859-4015
Practice Fax: 864-859-3396

1619226404 — MRS. CARYN NIX PETRATOS R. PH.
Practice Location Address:

101 W MAIN ST
EASLEY, SC
29640-2038

Practice Phone: 864-859-4015
Practice Fax: 864-859-3396

1699639609 — LINDSEY WELLNESS & BEHAVIORAL HEALTH CLINIC LLC
Practice Location Address:

116 KAY DR STE B
EASLEY, SC
29640-8997

Practice Phone: 864-787-7122
Practice Fax: 864-751-5212

1528920089 — SHAQUELAH WALTERS
Practice Location Address:

208 E 1ST AVE
EASLEY, SC
29640-3039

Practice Phone: 864-898-5800
Practice Fax:

Directions to “FREDS STORES OF TENNESSEE INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.