FREDS STORES OF TENNESSEE INC (NPI# 1023040060) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023040060 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 1236 |
| Practice Address |
456 Highway 24 E Centreville MS 39631-4128 |
| Mailing Address |
6625 Lenox Park Blvd. Suite 200 Memphis TN 38115 |
| Practice Telephone | 6016459190 |
| Practice Fax Number | 6016459165 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-08-30 |
| Authorized Official Name | JOSEPH ANTO (CEO) |
| Authorized Official Telephone | 9013623733 |
| 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 | 0423301FC | MS | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
0423301FC | MS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 2519366 | 01 | |
| MS | 0330428 | 05 |
| Other Name | Type Code |
|---|---|
| FREDS PHARMACY 1236 | 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 |
456 HIGHWAY 24 E |
| City | CENTREVILLE |
| State | MS |
| Zip Code | 39631-4128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780152561 | Charles Gerald Rymer | Pharmacist | 456 Highway 24 E, Centreville, MS 39631-4128 | 2018-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972159994 | Jelks Family Pharmacy, LLC | Pharmacy | 1404 Academy St, Centreville, MS 39631 | 2019-08-15 |
| 1275946162 | James Hawley | Nurse Practitioner | 260 W Main Street, Centreville, MS 39631 | 2014-06-09 |
| 1730342643 | Field Memorial Community Hospital | Internal Medicine | 270 W Main Street, Centreville, MS 39631 | 2008-07-10 |
| 1184806747 | Field Memorial Community Hospital | Nurse Practitioner | 143 West Howard St, Centreville, MS 39631 | 2007-12-05 |
| 1245528785 | Se Mississippi Emergency Physicians LLC | Emergency Medicine | 270 West Main Street, Centreville, MS 39631 | 2011-07-19 |
| 1609105014 | King Louis Chambers | Public Health or Welfare | 506 E. Main St., Suite 2a, Centreville, MS 39631 | 2009-12-14 |
| 1710016233 | James L. Jelks Jr. | Pharmacist | 149 Main St., Centreville, MS 39631-0159 | 2007-03-02 |
| 1548244262 | Wilkinson County Nursing Center LLC | Skilled Nursing Facility | 166 S Lafayette St, Centreville, MS 39631-0310 | 2005-12-06 |
| 1992024459 | David Mcinnis Berry | Emergency Medicine | 270 W. Main St., Centreville, MS 39631-0639 | 2010-05-24 |
| 1053503318 | Wilkinson County Senior Care LLC | Skilled Nursing Facility | 166 S Lafayette St, Centreville, MS 39631-3571 | 2007-08-10 |
| Find all providers in zip 39631 | ||||
| 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 |
|---|---|---|---|---|
| 1467081273 | Chungkang Pharmacy, LLC | Pharmacy | 14637 Lee Hwy # 109b, Centreville, VA 20121-5829 | 2020-04-03 |
| 1972159994 | Jelks Family Pharmacy, LLC | Pharmacy | 1404 Academy St, Centreville, MS 39631 | 2019-08-15 |
| 1871086082 | Medicate Pharmacy Inc | Pharmacy | 5869 Bond Ave, Centreville, IL 62207-2300 | 2018-06-12 |
| 1669901815 | Bridge Healthcare Pharmacy LLC | Pharmacy | 658 E. Main St, Suite 1, Centreville, MI 49032 | 2017-06-09 |
| 1053865337 | Chungkang Pharmacy, LLC | Pharmacy | 14637 Lee Highway, #109b, Centreville, VA 20121 | 2016-08-04 |
| 1134426372 | One Stop Pharmacy Inc | Pharmacy | 13818-b Braddock Rd, Centreville, VA 20121 | 2011-02-24 |
| 1184886145 | Hairston & Dixon Inc | Pharmacy | 14260c Centreville Sq, Centreville, VA 20121-2364 | 2008-06-30 |
| 1265570428 | J & S Drugs, Inc | Pharmacy | 1130 Walnut St, Centreville, AL 35042-2811 | 2007-02-01 |
| 1508969221 | Alabama Cvs Pharmacy, L.L.C. | Pharmacy | 155 Birmingham Rd Ste 114, Centreville, AL 35042-2949 | 2006-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164038485 | Quinn's Family Pharmacy of Newton | Pharmacy | 193 Northside Dr, Newton, MS 39345-9523 | 2020-09-22 |
| 1194339275 | Friendship, LLC | Pharmacy | 4123 W Main St, Tupelo, MS 38801 | 2020-09-04 |
| 1649883844 | Natchez Wellness Pharmacy | Pharmacy | 29 Sergeant Prentiss Dr Ste 5, Natchez, MS 39120-4743 | 2020-08-26 |
| 1952910366 | Ct Stamps Inc | Pharmacy | 206 Marion Avenue, Mccomb, MS 39648 | 2020-07-31 |
| 1114566122 | Valley Drugs, Inc. | Pharmacy | 327b S Main St, Water Valley, MS 38965-3318 | 2019-12-23 |
| 1851939318 | Smith Pharmacy, Inc. | Pharmacy | 306 Northside Drive, Newton, MS 39345 | 2019-12-16 |
| 1285270801 | Proxsys Rx - Rush LLC | Pharmacy | 14916 Hwy 16 W, Unit #1, Dekalb, MS 39328 | 2019-11-19 |
| 1518501592 | Southwest Pharmacy Inc | Pharmacy | 3000 Plaza Dr Ste B, Tylertown, MS 39667-9227 | 2019-11-01 |
| 1669015210 | Hometown Family Pharmacy, Inc. | Pharmacy | 930 Hall St Ste H, Wiggins, MS 39577-2113 | 2019-10-25 |
| 1225671001 | A & A Infusion & Specialty, LLC | Pharmacy | 124 E Jackson St, Belzoni, MS 39038-3642 | 2019-10-23 |
| Find all providers with the same taxonomy | ||||
| City | CENTREVILLE |
| Zip Code | 39631 |
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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.