FREDS STORES OF TENNESSEE INC (NPI# 1407860398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407860398 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 2646 |
| Practice Address |
114 W Knight St Portland TN 37148-1415 |
| Mailing Address |
4300 New Getwell Rd Memphis TN 38118-6801 |
| Practice Telephone | 6153254141 |
| Practice Fax Number | 6153257423 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2009-09-18 |
| 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 | 333600000X | Pharmacy | C1071 | TN | Suppliers |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | C1071 | TN | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
C1071 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 9440469 | 05 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 4431057 | 01 |
| Other Name | Type Code |
|---|---|
| FREDS PHARMACY 2646 | 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 |
114 W KNIGHT ST |
| City | PORTLAND |
| State | TN |
| Zip Code | 37148-1415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831495753 | Renee Ashley Moss | Pharmacist | 114 W Knight St, Portland, TN 37148-1415 | 2011-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427608645 | Carehere LLC | Family Medicine | Carehere Clinic- Nasg Portland, Tn, 160 Kirby Drive, Portland, TN 37148 | 2019-09-19 |
| 1710494117 | Lydia Ellen Hicks | Registered Nurse | 214 W. Longview Drive, Portland, TN 37148 | 2018-01-08 |
| 1487903696 | Jennifer Leigh Toney | Registered Nurse | 101 Maurice Ct, Portland, TN 37148 | 2012-09-04 |
| 1366712770 | Pamela Poghen | Registered Nurse | 235 Hwy 52 E, Portland, TN 37148 | 2012-01-03 |
| 1003090036 | State of Tennessee | Public Health or Welfare | 214 West Longview Drive, Portland, TN 37148 | 2007-12-27 |
| 1437256930 | Tennessee Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 304 A S Broadway Ste A, Portland, TN 37148 | 2006-09-20 |
| 1568494243 | Melissa R Cook | Nurse Practitioner | 932-b South Broadway, Portland, TN 37148 | 2006-07-06 |
| 1225200306 | Lisa Nazarenus | Nurse Practitioner | 307 S Broadway, Portland, TN 37148 | 2008-03-28 |
| 1770523748 | Jason A Bruns | Physical Therapist | 121 Village Dr, 103, Portland, TN 37148 | 2006-06-07 |
| 1841350196 | Edward Freeman Kirkpatrick Jr. | Dentist | 307 Reed St, Portland, TN 37148-0410 | 2006-12-09 |
| Find all providers in zip 37148 | ||||
| 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] |
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| 1649800186 | A & S Pharmacy LLC | Pharmacy | 1660 Wildcat Dr, Portland, TX 78374-2830 | 2020-01-23 |
| 1508337577 | Oregon Health & Science University | Pharmacy | 3303 Sw Bond Ave Rm 1090, Portland, OR 97239-4501 | 2018-12-17 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1538653654 | Division Pharmacy Inc. | Pharmacy | 10918 Se Division St, Portland, OR 97266-1259 | 2018-06-21 |
| 1659755593 | Portland Professional Pharmacy, LLC | Pharmacy | 11717 Ne Glisan St, Portland, OR 97220-2141 | 2015-07-09 |
| 1992194062 | Professionl Pharmacy | Pharmacy | 10000 Se Main St Ste 201, Portland, OR 97216-2448 | 2015-01-13 |
| 1932597978 | Pharmaca Integrative Pharmacy, Inc | Pharmacy | 240 Nw Lost Springs Terrace, Suite 36, Portland, OR 97229 | 2014-12-29 |
| Find all providers in PORTLAND | ||||
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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.