FREDS STORES OF TENNESSEE INC (NPI# 1639107618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639107618 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 1201 |
| Practice Address |
1212 Military Rd Benton AR 72015-2908 |
| Mailing Address |
4300 New Getwell Rd Memphis TN 38118-6801 |
| Practice Telephone | 5017782036 |
| Practice Fax Number | 5017786899 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2010-01-04 |
| Authorized Official Name | 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 | 333600000X | Pharmacy | 417255 | AR | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
417255 | AR | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 0417255 | 01 | |
| AR | 120515407 | 05 | |
| AR | DME | 156772716 | 01 |
| Other Name | Type Code |
|---|---|
| FREDS PHARMACY 1201 | 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 |
1212 MILITARY RD |
| City | BENTON |
| State | AR |
| Zip Code | 72015-2908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790343135 | Justin King | Case Manager/Care Coordinator | 1502 Mary Kay Blv6, Benton, AR 72015 | 2019-05-31 |
| 1790253326 | Seth Alexander Weisheit | Nurse Practitioner | 824 Military Road, Benton, AR 72015 | 2018-11-13 |
| 1396269627 | Abby G Sims | Speech-Language Pathologist | 3391 Peachtree Lane, Benton, AR 72015 | 2017-07-28 |
| 1225551278 | Jessica R Poe | Case Manager/Care Coordinator | 1502 Marykay Blvd, Benton, AR 72015 | 2017-07-21 |
| 1003357997 | Jamaal Langston | Case Manager/Care Coordinator | 1502 Mark Kay Blvd, Benton, AR 72015 | 2017-03-13 |
| 1881138550 | Shannon Gachot-ridgley | Counselor | 205 South Street Suite 3, Benton, AR 72015 | 2016-12-14 |
| 1295104578 | Excel Health of Haskell, Pllc | Clinical Nurse Specialist | 6029 Us Hwy 67, Haskell, AR 72015 | 2015-09-17 |
| 1528464054 | Kacey Jo Kiker | Nurse Practitioner | 620 W South St, Benton, AR 72015 | 2014-11-11 |
| 1700218252 | Jamie Brunt | Licensed Practical Nurse | 1718 Old Hot Springs Rd, Benton, AR 72015 | 2013-08-07 |
| 1760738942 | Kari J Richards | Physical Therapist | 5701 Springhill Rd, Bryant, AR 72015 | 2012-07-25 |
| Find all providers in zip 72015 | ||||
| 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 |
|---|---|---|---|---|
| 1316580939 | Jw Pharmacy Inc | Pharmacy | 34 Us Highway 68 E Unit A, Benton, KY 42025-8336 | 2019-10-27 |
| 1124040795 | Colpharm Inc | Pharmacy | 283-285 Main St, Benton, PA 17814-0251 | 2006-07-24 |
| 1720592215 | Vine Pharmacy | Pharmacy | 4375 Red Rock Rd, Benton, PA 17814-7948 | 2017-11-20 |
| 1861740615 | Kentucky Cvs Pharmacy, LLC | Pharmacy | 405 Main St, Benton, KY 42025-1119 | 2012-08-28 |
| 1003956152 | J&k Pharmacy, Inc. | Pharmacy | 1112 Main St, Benton, KY 42025-1450 | 2007-02-07 |
| 1144301136 | Access Pharmacy | Pharmacy | 920 Edison Ave, Suite 9, Benton, AR 72015-4502 | 2006-10-18 |
| 1457454225 | Highland Park Cvs, L.L.C. | Pharmacy | 705 W Main St, Benton, IL 62812-1329 | 2006-09-07 |
| 1558478925 | Freds Stores of Tennessee Inc | Pharmacy | 5604 Hwy 3, Benton, LA 71006 | 2006-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356942320 | Freda Cunningham | Pharmacy | 2100 Hwy 77, Marion, AR 72364 | 2020-11-05 |
| 1457978157 | Sc Pharmacy Group Opco LLC | Pharmacy | 1800 Riverfront Dr Ste 100, Little Rock, AR 72202-1882 | 2020-06-29 |
| 1790306124 | Jbr Enterprises Inc | Pharmacy | 600 Hwy 365, Mayflower, AR 72106 | 2020-04-27 |
| 1215557905 | Medman23, Inc | Pharmacy | 3201 Springhill Dr Ste 110, North Little Rock, AR 72117-2910 | 2020-04-22 |
| 1336768985 | Harps Food Stores, Inc | Pharmacy | 611 Highway 62 65 N, Harrison, AR 72601-2208 | 2020-04-14 |
| 1598393605 | Highlands Oncology Group Pa | Pharmacy | 3901 Parkway Circle, Springdale, AR 72762 | 2020-04-01 |
| 1326674870 | Caraway Drug L.l.c | Pharmacy | 106 W. State Street, Caraway, AR 72419 | 2020-03-17 |
| 1104461532 | Pruett's Food, Inc. | Pharmacy | 101 W. Main, Lockesburg, AR 71846 | 2019-11-08 |
| 1760025274 | Holiday Island Pharmacy, LLC | Pharmacy | 2 Forest Park Dr Ste A, Holiday Island, AR 72631-9229 | 2019-10-28 |
| 1730722463 | Beebe Family Pharmacy, LLC | Pharmacy | 1701 W Dewitt Henry Dr, Beebe, AR 72012-2024 | 2019-10-25 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on FREDS STORES OF TENNESSEE INC.
| 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.