FREDS STORES OF TENNESSEE INC (NPI# 1073814455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073814455 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 3614 |
| Practice Address |
6129 Calhoun Memorial Hwy Ste C Easley SC 29640-3781 |
| Mailing Address |
4300 New Getwell Rd Memphis TN 38118-6801 |
| Practice Telephone | 8648594077 |
| Mailing Telephone | 9012382520 |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2011-08-09 |
| Authorized Official Name | DR. RICKY CHAMBERS (VP) |
| Authorized Official Telephone | 9012382477 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | Y |
| Parent Organization Name | FREDS INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | 711226 | SC | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MEDICAID DME | DE3370 | 01 |
| SC | 711226 | 05 |
| Other Name | Type Code |
|---|---|
| Freds Pharmacy 3614 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427454511 | Freds Stores of Tennessee Inc | Pharmacy | 211 Three Oaks Drive, Medina, TN 38355 | 2014-11-17 |
| 1710383690 | Freds Stores of Tennessee Inc | Pharmacy | 810 Se Washington St, Idabel, OK 74745-3442 | 2014-11-05 |
| 1265836142 | Freds Stores of Tennessee Inc | Pharmacy | 1068 Highway 61 N., Tunica, MS 38676 | 2014-10-21 |
| 1740699958 | Freds Stores of Tennessee Inc | Pharmacy | 510 S. Thomson Avenue, Iowa, LA 70647 | 2014-08-13 |
| 1801207287 | Freds Stores of Tennessee Inc | Pharmacy | 988 Erwin Rd, Dunn, NC 28334-4526 | 2014-05-19 |
| 1205247681 | Freds Stores of Tennessee Inc | Pharmacy | 2311 E Morris St, Dalton, GA 30721-4373 | 2014-05-19 |
| 1861802134 | Freds Stores of Tennessee Inc | Pharmacy | 201 Walnut Street, Montezuma, GA 31063 | 2014-05-07 |
| 1851719199 | Freds Stores of Tennessee Inc | Pharmacy | 218 East M W Watson Blvd., Daingerfield, TX 75638-2038 | 2014-04-03 |
| 1942623889 | Freds Stores of Tennessee Inc | Pharmacy | 604 Northside Drive, Statesboro, GA 30458 | 2014-01-29 |
| 1972934263 | Freds Stores of Tennessee Inc | Pharmacy | 312 Main Street Hwy 19, Baker, LA 70714 | 2013-12-11 |
| Street Address |
6129 CALHOUN MEMORIAL HWY STE C |
| City | EASLEY |
| State | SC |
| Zip Code | 29640-3781 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588914162 | James Oliver Ivey Jr. | Pharmacist | 6129 Calhoun Memorial Hwy Ste C, Easley, SC 29640-3781 | 2012-09-11 |
| 1174873863 | Rosemary Duncan | Pharmacist | 6129 Calhoun Memorial Hwy Ste C, Easley, SC 29640-3781 | 2012-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063935773 | Mary Kathryn Henderson | Speech-Language Pathologist | 1400 Griffin Mill Road, Easley, SC 29640 | 2017-07-25 |
| 1417309451 | Ashby Park Pediatric Dentistry Easley | Dentist | 708 North A Street, Easley, SC 29640 | 2016-07-01 |
| 1548696990 | Phuong T Tran | Pharmacist | 309 Rolling Hills Circle, Easley, SC 29640 | 2013-09-17 |
| 1538593017 | Baptist Easley Hospital | Clinic/Center | 200 Fleet Wood Dr 3 Rd Floor, Easley, SC 29640 | 2013-09-03 |
| 1942507173 | Joanne Mason Wilkinson | Occupational Therapist | 1807a East Main St, Easley, SC 29640 | 2011-02-24 |
| 1861793911 | Ark Pharmacy Services LLC | Pharmacy | 5119- A Calhoun Memorial Hwy, Easley, SC 29640 | 2010-11-05 |
| 1659507952 | Sarah Elizabeth Proulx | Dentist | 227 South Pendleton Street, Suita A, Easley, SC 29640 | 2009-06-02 |
| 1508030503 | Jean Claire Palmour | Massage Therapist | 404 South Fifth Street, Jj & Company Salon & Spa, Easley, SC 29640 | 2008-04-22 |
| 1760685143 | Cannon Memorial Hospital | Family Medicine | 111 W. Roper Rd., Easley, SC 29640 | 2007-06-06 |
| 1942419171 | William Kent Hammond | Dentist | 298 Enterprise Dr, Easley, SC 29640 | 2007-05-22 |
| Find all providers in zip 29640 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053788638 | Rpvr Corporation | Pharmacy | 121 Fleetwood Dr, Easley, SC 29640-2019 | 2015-08-30 |
| 1902900707 | South Carolina Cvs Pharmacy LLC | Pharmacy | 1063 S Pendleton St, Easley, SC 29642-1040 | 2006-09-12 |
| 1134170764 | Medical Center Inc. of Pickens | Pharmacy | 838 Powdersville Rd, Suite D, Easley, SC 29642-3703 | 2006-05-16 |
| 1255982567 | Oracle Pharmacy | Pharmacy | 1040 S Pendleton St Ste C, Easley, SC 29642-1047 | 2019-09-27 |
| 1588002497 | Ingles Markets Inc | Pharmacy | 5251 Calhoun Memorial Hwy, Easley, SC 29642 | 2013-06-13 |
| 1346412939 | Ingles Markets Inc | Pharmacy | 410 Pelzer Hwy, Easley, SC 29642-2106 | 2008-03-24 |
| 1932118411 | Powdersville Pharmacy, Pa | Pharmacy | 10701 Anderson Rd, Easley, SC 29642-9309 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720535 | Detyens Medical Center | Pharmacy | 1670 Drydock Avenue, Building 10, Suite A, North Charleston, SC 29405 | 2020-11-03 |
| 1053918458 | Johns Island Pharmacy LLC | Pharmacy | 3133 Maybank Hwy, Johns Island, SC 29455-4838 | 2020-10-08 |
| 1821695735 | Msm Rx LLC | Pharmacy | 6323b N Main St, Columbia, SC 29203-4733 | 2020-10-04 |
| 1235743295 | Kp and Rd LLC | Pharmacy | 721 N Greenwood Avenue, Ware Shoals, SC 29692 | 2020-09-06 |
| 1265045322 | Ptvp | Pharmacy | 8007 Warren H Abernathy Hwy, Spartanburg, SC 29301-2449 | 2020-08-28 |
| 1841801669 | Christmas Pharmacy LLC | Pharmacy | 1229 Alice Dr # B, Sumter, SC 29150-1970 | 2020-08-14 |
| 1639796022 | Wall Drugs of Pamplico, Inc. | Pharmacy | 616 S. Walnut Street, Pamplico, SC 29583 | 2020-07-01 |
| 1851913974 | Ebenezer Health Investors Inc | Pharmacy | 3217 Devine St, Columbia, SC 29205-1847 | 2020-05-12 |
| 1457971541 | Nephron Pharmacy LLC | Pharmacy | 4500 12th Street Ext Ste B, West Columbia, SC 29172-3025 | 2020-04-20 |
| 1770112849 | Fountain Inn Rx LLC | Pharmacy | 106 S Weston St, Fountain Inn, SC 29644-1940 | 2020-04-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.