Provider Demographics
NPI:1184817678
Name:FREDS STORES OF TENNESEE INC
Entity Type:Organization
Organization Name:FREDS STORES OF TENNESEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-238-2477
Mailing Address - Street 1:PO BOX 2121
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38159-0001
Mailing Address - Country:US
Mailing Address - Phone:901-238-2580
Mailing Address - Fax:901-365-9820
Practice Address - Street 1:4300 NEW GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-6801
Practice Address - Country:US
Practice Address - Phone:901-238-2520
Practice Address - Fax:901-365-9820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRED'S INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy