FRED'S STORES OF TENNESSEE INC. (NPI# 1548662315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548662315 |
| Entity Type | Organization |
| Organization Name | FRED'S STORES OF TENNESSEE INC. |
| Other Organization Name | FRED'S PHARMACY 1164 |
| Practice Address |
1718 S Waukesha St Bonifay FL 32425-3114 |
| Mailing Address |
6625 Lenox Park Blvd. Suite 200 Memphis TN 38115 |
| Practice Telephone | 9012382520 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2019-08-30 |
| Authorized Official Name | JOSEPH ANTO (CEO) |
| Authorized Official Telephone | 9013623733 |
| Is Organization Subpart | Y |
| Parent Organization Name | FRED'S INC. |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 014023500 | 05 |
| Other Name | Type Code |
|---|---|
| Fred's Pharmacy 1164 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497117881 | Fred's Stores of Tennessee Inc. | Pharmacy | 1550 S. Zach Hinton Parkway, Mcdonough, GA 30253 | 2016-03-24 |
| 1629443429 | Fred's Stores of Tennessee Inc. | Pharmacy | 620 E Franklin St Ste A, Sylvester, GA 31791-7189 | 2015-12-04 |
| 1043684228 | Fred's Stores of Tennessee Inc. | Pharmacy | 1803 E Gentry Pkwy, Tyler, TX 75702-3564 | 2015-11-25 |
| 1053785238 | Fred's Stores of Tennessee Inc. | Pharmacy | 1123 State Highway 110 N, Whitehouse, TX 75791-3055 | 2015-11-25 |
| 1083088512 | Fred's Stores of Tennessee Inc. | Pharmacy | 1938 Main Street, Cadiz, KY 42211 | 2015-11-20 |
| 1346632460 | Fred's Stores of Tennessee Inc. | Durable Medical Equipment & Medical Supplies | 4401 Bemiss Rd, Valdosta, GA 31605-6049 | 2015-02-26 |
| 1639561756 | Fred's Stores of Tennessee Inc. | Pharmacy | 1442 Tift Ave N, Tifton, GA 31794-3545 | 2015-02-26 |
| 1023410727 | Fred's Stores of Tennessee Inc. | Pharmacy | 94 Upper Riverdale Rd Sw, Riverdale, GA 30274-2622 | 2014-09-24 |
| 1750870192 | Fred's Stores of Tennessee Inc. | Pharmacy | 1801 Memorial Blvd, Murfreesboro, TN 37129-1522 | 2018-05-01 |
| 1528509239 | Fred's Stores of Tennessee Inc. | Pharmacy | 13907 High Rd, Mabelvale, AR 72103-3212 | 2017-03-14 |
| Street Address |
1718 S WAUKESHA ST |
| City | BONIFAY |
| State | FL |
| Zip Code | 32425-3114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124650270 | Elizabeth H Lolley | Counselor | 1987 Remington Pl, Bonifay, FL 32425 | 2020-02-06 |
| 1891333274 | Traci Corbin | Registered Nurse | 603 Scenic Hill Circle, Bonifay, FL 32425 | 2019-12-16 |
| 1912339565 | Cb Health Ventures, Inc. | Assisted Living Facility | 108 Wagner Rd., Bonifay, FL 32425 | 2013-08-06 |
| 1558538868 | Patrick L Hawkins | Family Medicine | 3120 Southride Lane, Bonifay, FL 32425 | 2008-05-15 |
| 1477763860 | Pak Rural Health | Internal Medicine | 812 S. Weeks St, Bonifay, FL 32425 | 2007-05-23 |
| 1073680245 | Ahmad Tariq Ismail | Family Medicine | 110 East Byrd Ave, Bonifay, FL 32425 | 2006-11-30 |
| 1982775805 | County of Holmes Office Clerk Board of County Commissioners | Ambulance | 949 E. Hwy 90, Bonifay, FL 32425 | 2006-11-13 |
| 1710080890 | Bonifay Nsg & Rehab | Assisted Living Facility | 304 N Brock Ave, Bonifay, FL 32425 | 2006-09-06 |
| 1710949318 | Florida Department of Health | Public Health or Welfare | 603 Scenic Circle, Bonifay, FL 32425 | 2006-04-06 |
| 1366431702 | Holmes County Hospital Corporation | General Acute Care Hospital | 2600 Hospital Drive, Bonifay, FL 32425 | 2005-10-18 |
| Find all providers in zip 32425 | ||||
| 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 |
|---|---|---|---|---|
| 1649871583 | Florida Community Health Centers, Inc. | Pharmacy | 9576 S Us Highway 1, Port Saint Lucie, FL 34952-4217 | 2020-11-06 |
| 1053911883 | Nrc Pharmd Inc | Pharmacy | 2700 Immokalee Rd Ste 24, Naples, FL 34110-1437 | 2020-10-30 |
| 1073112116 | Hl72 LLC | Pharmacy | 5193 Clark Rd, Sarasota, FL 34233-3213 | 2020-10-20 |
| 1689280851 | Unique Pharmacy Corp | Pharmacy | 7800 Sw 87th Ave Ste 210b, Miami, FL 33173-2537 | 2020-09-22 |
| 1033723127 | Five Pillars Corporation | Pharmacy | 2301 N University Dr Ste 112, Pembroke Pines, FL 33024-3617 | 2020-09-04 |
| 1780297655 | Healthy Living Pharmacy LLC | Pharmacy | 755 Rosemary Cir, Bradenton, FL 34212-5015 | 2020-08-28 |
| 1326651555 | Purformance Wellness Pharmacy LLC | Pharmacy | 600 Se Indian St Ste 3, Stuart, FL 34997-5540 | 2020-08-27 |
| 1043822620 | Specialtycarerx LLC | Pharmacy | 821 N Us Highway 1 Ste A, Ormond Beach, FL 32174-4528 | 2020-08-17 |
| 1831700855 | Kingsley Rx LLC | Pharmacy | 1542 Kingsley Ave Ste 142, Orange Park, FL 32073-4547 | 2020-08-13 |
| 1104435742 | Easyscripts LLC | Pharmacy | 2601 S Military Trl Ste 1, West Palm Beach, FL 33415-7509 | 2020-07-29 |
| 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.