FREDS STORES OF TENNESSEE INC (NPI# 1184656027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184656027 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 1766 |
| Practice Address |
535 W Main St Henderson TN 38340-2536 |
| Mailing Address |
6625 Lenox Park Blvd. Suite 200 Memphis TN 38115 |
| Practice Telephone | 7319899933 |
| Practice Fax Number | 7319899934 |
| 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 | 332B00000X | Durable Medical Equipment & Medical Supplies | C2324 | TN | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
C2324 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 9449798 | 05 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 4427135 | 01 |
| Other Name | Type Code |
|---|---|
| FREDS PHARMACY 1766 | 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 |
535 W MAIN ST |
| City | HENDERSON |
| State | TN |
| Zip Code | 38340-2536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477863959 | Cynthia Vincent Moss | Pharmacist | 535 W Main St, Henderson, TN 38340-2536 | 2010-10-18 |
| 1306489554 | Integration Partners LLC | Durable Medical Equipment & Medical Supplies | 535 W Main St, Henderson, TN 38340-2536 | 2019-10-21 |
| 1225511975 | Diana Booth White | Pharmacist | 535 W Main St, Henderson, TN 38340-2536 | 2018-09-10 |
| 1487095667 | Fred's Pharmacy | Pharmacy | 535 W Main St, Henderson, TN 38340-2536 | 2013-07-16 |
| 1205189487 | Mark Dearth | Pharmacist | 535 W Main St, Henderson, TN 38340-2536 | 2012-10-24 |
| 1528364742 | Janice C Morris | Pharmacist | 535 W Main St, Henderson, TN 38340-2536 | 2011-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407487390 | Cornerstone Pharmacy, LLC | Pharmacy | 1330 Us Hwy 45 N Ste D, Henderson, TN 38340 | 2020-01-29 |
| 1184774358 | State of Tennessee | Public Health or Welfare | 301 Quinco Drive, Henderson, TN 38340 | 2007-01-11 |
| 1952381089 | Ronald Allen Hoffmeyer | Physician Assistant | 1132 Industrial Drive, Henderson Health Center, Henderson, TN 38340 | 2006-01-17 |
| 1487636031 | Ronald E Johnson | Dentist | 136 South Washington Ave, Henderson, TN 38340-0096 | 2005-11-18 |
| 1174835664 | Southwest Human Resource Agency | Local Education Agency (LEA) | 1527 White Avenue, Henderson, TN 38340-0264 | 2010-07-13 |
| 1366637969 | Hardeman County Community Health Center | Clinic/Center | 1132 Industrial Dr, Henderson, TN 38340-1310 | 2007-09-07 |
| 1629380639 | Candice Johnson Jones | Family Medicine | 1132 Industrial Dr, Henderson, TN 38340-1310 | 2010-07-07 |
| 1578510269 | Henderson Residential, LLC | Assisted Living Facility | 558 White Ave, Henderson, TN 38340-1504 | 2006-05-28 |
| 1457591117 | Melaro Behavioral Consultants Inc | Clinic/Center | 225 W Sixth St, Henderson, TN 38340-1515 | 2009-02-20 |
| 1386797314 | David Allen Magee | Dentist | 1520 Cherry Creek Cv, Henderson, TN 38340-1578 | 2007-01-21 |
| Find all providers in zip 38340 | ||||
| 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 |
|---|---|---|---|---|
| 1558980599 | Total Infusion Care Inc | Pharmacy | 3041 W Horizon Ridge Pkwy Ste 100, Henderson, NV 89052-4444 | 2020-04-09 |
| 1407487390 | Cornerstone Pharmacy, LLC | Pharmacy | 1330 Us Hwy 45 N Ste D, Henderson, TN 38340 | 2020-01-29 |
| 1508333899 | Khoi Ha Pllc | Pharmacy | 3175 Saint Rose Pkwy Ste 120, Henderson, NV 89052-3507 | 2018-10-25 |
| 1457758948 | Atlas Specialty Pharmacy LLC | Pharmacy | 301 N Pecos Rd Ste D, Henderson, NV 89074-1350 | 2014-11-26 |
| 1982834131 | Valley Lake Inc | Pharmacy | 2245 N Green Valley Pkwy, Henderson, NV 89014-5024 | 2009-07-22 |
| 1164661914 | Jib Enterprises LLC | Pharmacy | 1590 W Horizon Ridge Pkwy, Suite#130, Henderson, NV 89012-3507 | 2009-02-18 |
| 1518033273 | Pharmacy Corporation of America | Pharmacy | 1910 Ross Mill Rd, Henderson, NC 27537-8789 | 2006-11-27 |
| 1881781557 | Donald Frank Norris | Pharmacy | 1060 N Main St, Henderson, NE 68371-0711 | 2006-10-06 |
| 1669571972 | Warm Springs Road Cvs, L.L.C. | Pharmacy | 21 W Horizon Ridge Pkwy, Henderson, NV 89012-5307 | 2006-09-22 |
| 1457453714 | Walgreen Co. | Pharmacy | 402 2nd St, Henderson, KY 42420-3221 | 2006-09-05 |
| Find all providers in HENDERSON | ||||
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.