FREDS STORES OF TENNESSEE INC (NPI# 1578595500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578595500 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 2166 |
| Practice Address |
307 Patton Ave Brookwood S/c Lafayette GA 30728 |
| Mailing Address |
4300 New Getwell Rd Memphis TN 38118-6801 |
| Practice Telephone | 7066386931 |
| Practice Fax Number | 7066388936 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2008-01-11 |
| 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 | 6529 | GA | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
6529 | GA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00318249A | 05 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 1129279 | 01 |
| Other Name | Type Code |
|---|---|
| FREDS PHARMACY 2166 | 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 |
307 PATTON AVE BROOKWOOD S/C |
| City | LAFAYETTE |
| State | GA |
| Zip Code | 30728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395620 | Primary Health Care Center of Dade, Inc. | Clinic/Center | 8a Probasco Street Unit 214, Lafayette, GA 30728 | 2020-10-30 |
| 1891358750 | K -va -t Food Stores Inc | Durable Medical Equipment & Medical Supplies | 311 North Main Street, Lafayette, GA 30728 | 2019-04-17 |
| 1023505914 | Heather Staton | Pharmacist | 324 W. Patton Street, Lafayette, GA 30728 | 2018-04-17 |
| 1023484805 | Tyler Kellum Levie | Dentist | 201 E. Villanow Street, Lafayette, GA 30728 | 2015-08-17 |
| 1083987481 | Krishawna Elaine Montgomery | Counselor | 501 Mize Street Lookout Mountain Community Services, Lafayette, GA 30728 | 2012-02-15 |
| 1346518198 | William Randall Smith | Behavioral Analyst | 902 Daugherty Street, Lafayette, GA 30728 | 2011-12-08 |
| 1821321506 | John H Rockwell | Contractor | 143 Golden Oaks Dr, La Fayette, GA 30728 | 2009-09-11 |
| 1619113057 | Lookout Mountain Community Services | Community/Behavioral Health | 43 Shady Court, Lafayette, GA 30728 | 2009-01-06 |
| 1326212705 | Lookout Mountain Community Services | Community/Behavioral Health | 1218 Chattanooga St., Lafayette, GA 30728 | 2008-04-17 |
| 1649444084 | Lookout Mountain Community Services | Community/Behavioral Health | 29 Mae Tucker Rd., Lafayette, GA 30728 | 2008-04-16 |
| Find all providers in zip 30728 | ||||
| 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 |
|---|---|---|---|---|
| 1174008064 | Province Pharmacy Inc | Pharmacy | 5000 Ambassador Caffery Pkwy Ste B, Lafayette, LA 70508-6984 | 2018-09-26 |
| 1700385663 | Ggii Indiana, LLC | Pharmacy | 2250 Teal Rd, Lafayette, IN 47905-2218 | 2018-02-06 |
| 1962914234 | Ksc, Inc | Pharmacy | 526 Highway 52 Byp W, Lafayette, TN 37083-1614 | 2017-10-26 |
| 1447706700 | Medicine Bin Plus LLC | Pharmacy | 1105 West Willow St, Lafayette, LA 70501 | 2016-08-28 |
| 1922493337 | Neighbors Pharmacy | Pharmacy | 6770 Johnston St, Suite-a, Lafayette, LA 70503-6202 | 2015-04-02 |
| 1154663284 | Acadiana Prescription Shop South | Pharmacy | 5000 Ambassador Caffery Pkwy.,bldg 3, Suite B, Lafayette, LA 70508 | 2013-03-27 |
| 1568693505 | Falcon Pharmacy LLC | Pharmacy | 1103 Kaliste Saloom Rd Ste 103, Lafayette, LA 70508-5783 | 2009-08-06 |
| 1659437929 | Kroger Limited Partnership I | Pharmacy | 2200 Greenbush St, Lafayette, IN 47904-2342 | 2006-12-29 |
| 1285730382 | Thrifty Way Pharmacy, Northside Inc. | Pharmacy | 1419 Moss St, Lafayette, LA 70501-3654 | 2006-09-15 |
| 1881798726 | Louisiana Cvs Pharmacy, L.L.C. | Pharmacy | 3754 Moss St, Lafayette, LA 70507-5537 | 2006-09-12 |
| Find all providers in LAFAYETTE | ||||
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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.