FREDS STORES OF TENNESSEE INC (NPI# 1982636924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982636924 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 1256 |
| Practice Address |
200 Clinton Blvd Clinton MS 39056-5126 |
| Mailing Address |
4300 New Getwell Rd Memphis TN 38118-6801 |
| Practice Telephone | 6019243232 |
| Practice Fax Number | 6019242417 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-11-29 |
| 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 | 1832PFC | MS | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
1832PFC | MS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 2514075 | 01 | |
| MS | 08228391 | 05 |
| Other Name | Type Code |
|---|---|
| FREDS PHARMACY 1256 | 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 |
200 CLINTON BLVD |
| City | CLINTON |
| State | MS |
| Zip Code | 39056-5126 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376012724 | John Melvin Goolsby Jr. | Dentist | 457 Highway 80 East, Clinton, MS 39056 | 2018-11-15 |
| 1225534530 | Magnolia Allergy Clinic LLC | Internal Medicine | 402 Cynthia St Ste E, Clinton, MS 39056 | 2018-04-04 |
| 1578093704 | Melinda A Weisenberger | Specialist/Technologist | 4600 W Northside Drive, Clinton, MS 39056 | 2017-06-20 |
| 1962859702 | Telehealthone, LLC | Nurse Practitioner | 200 Clinton Plaza, Clinton, MS 39056 | 2016-05-23 |
| 1841686581 | 1st America Infusion Services LLC | Durable Medical Equipment & Medical Supplies | 132 Fairmont Street, Suite B, Clinton, MS 39056 | 2015-04-09 |
| 1023412822 | Rebecca Brooks Prewitt | Social Worker | 130 B Fairmont Street, Clinton, MS 39056 | 2014-10-22 |
| 1396184149 | Robert Joseph Hargis | Urology | 116 Afton Way, Clinton, MS 39056 | 2013-06-14 |
| 1750626321 | Clinton Dental Care, Inc. | Dentist | 736 Clinton Pkwy, Clinton, MS 39056 | 2012-12-07 |
| 1922394469 | Daphenia C. Knight Starling | Nurse Practitioner | Clinton Healthcare, 1251 Pinehaven Rd, Clinton, MS 39056 | 2011-06-23 |
| 1134443385 | Gwendolyn Coleman Garror | Pharmacist | 132 Fairmount Drive, Clinton, MS 39056 | 2010-03-17 |
| Find all providers in zip 39056 | ||||
| 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 |
|---|---|---|---|---|
| 1700342896 | Mendel Pharmacy Inc | Pharmacy | 9131 Piscataway Rd Ste 200, Clinton, MD 20735-2578 | 2019-02-14 |
| 1568902427 | Clinton Pharmacy LLC | Pharmacy | 119 E Clay St, Clinton, KY 42031-1222 | 2017-02-26 |
| 1063965101 | Jcm Enterprises Inc | Pharmacy | 910 N Charles G Seivers Blvd, Clinton, TN 37716-3816 | 2016-07-25 |
| 1154702900 | Hunts Mill Pharmacy Inc | Pharmacy | 14 Main St Fl 1, Clinton, NJ 08809 | 2015-06-17 |
| 1053702860 | Wal-mart Stores East Lp | Pharmacy | 9181 Highway 67, Clinton, LA 70722-4919 | 2015-02-16 |
| 1134543440 | Physicans Rx Pharmacy of Clinton Inc | Pharmacy | 9131 Piscataway Rd Ste 670, Clinton, MD 20735-2579 | 2014-02-06 |
| 1609216498 | Dirigo Drug LLC | Pharmacy | 1144 Main Street, Clinton, ME 04927 | 2013-06-26 |
| 1487942298 | Wagner Pharmacy Company | Pharmacy | 1726 N. 2nd Street, Clinton, IA 52732 | 2011-07-13 |
| 1184883019 | Walgreen Co | Pharmacy | 9001 Woody Ter Ste B, Clinton, MD 20735-4256 | 2008-06-05 |
| 1437362209 | Clinton Drugstore | Pharmacy | 1027 St Helena, Clinton, LA 70722-1027 | 2007-05-08 |
| Find all providers in CLINTON | ||||
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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.