FREDS STORES OF TENNESSEE, INC, (NPI# 1114255668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114255668 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE, INC, |
| Other Organization Name | FREDS PHARMACY 3351 |
| Practice Address |
505 Laurens Rd Woodruff SC 29388-2209 |
| Mailing Address |
4300 New Getwell Rd Memphis TN 38118-6801 |
| Practice Telephone | 8644763725 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2011-07-14 |
| Authorized Official Name | RICKY CHAMBERS (VP) |
| Authorized Official Telephone | 9012382477 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | Y |
| Parent Organization Name | FREDS INC |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | 10699 | SC | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
10699 | SC | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 710669 | 05 | |
| SC | MEDICAID DME | DE3367 | 01 |
| NCPDP | 4229313 | 01 |
| Other Name | Type Code |
|---|---|
| Freds Pharmacy 3351 | Doing Business As Name - Organization |
| Street Address |
505 LAURENS RD |
| City | WOODRUFF |
| State | SC |
| Zip Code | 29388-2209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457605008 | William Brady | Pharmacist | 505 Laurens Rd, Woodruff, SC 29388-2209 | 2012-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194336370 | Lindsay Jeanne Small | Behavioral Analyst | 751 East Georgia St, Woodruff, SC 29388 | 2020-08-12 |
| 1467092916 | Jessica Florez | Assistant Behavior Analyst | 751 E. Georgia St, Woodruff, SC 29388 | 2020-01-13 |
| 1124548862 | Virginia Lanier | Behavioral Analyst | 751 E Georgia Street, Woodruff, SC 29388 | 2017-06-23 |
| 1811434681 | Anna M Stoudenmire | Behavioral Analyst | 751 E Gerogia Road, Woodruff, SC 29388 | 2017-01-31 |
| 1912365883 | Nicole Vanegas | Behavioral Analyst | 751 East Georgia Road, Ste 100, Woodruff, SC 29388 | 2016-02-05 |
| 1215393871 | Shannon Leigh Tyner Thompson | Behavioral Analyst | 751 E. Georgia Street, Woodruff, SC 29388 | 2016-01-12 |
| 1255775730 | Samantha Jenkins Amick | Speech-Language Pathologist | 915 Cross Anchor Road, Woodruff, SC 29388 | 2013-04-26 |
| 1366792889 | Kathleen Brown Harrington | Pharmacist | 654 Chickenfoot Creek Road, Woodruff, SC 29388 | 2012-09-12 |
| 1093018228 | South Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 820 N. Main St., Woodruff, SC 29388 | 2010-12-09 |
| 1134448806 | Carolina Vision Associates, LLC | Optometrist | 363 E. Georgia St, Woodruff, SC 29388 | 2010-05-20 |
| Find all providers in zip 29388 | ||||
| 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 |
|---|---|---|---|---|
| 1679116453 | Cbtp Partners LLC | Pharmacy | 10195 Highway 221 Ste 5, Woodruff, SC 29388-9358 | 2019-10-23 |
| 1457514630 | Woodruff Family Pharmacy LLC | Pharmacy | 914 N Main St, Woodruff, SC 29388-9023 | 2008-07-08 |
| 1457382681 | Patton Pharmacy, Inc. | Pharmacy | 345 S Main St, Woodruff, SC 29388-1867 | 2006-07-05 |
| 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.