FREDS STORES OF TENNESSEE INC. (NPI# 1265878557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265878557 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC. |
| Other Organization Name | HUDSON DRUG STORE #3579 |
| Practice Address |
600 Nuckolls Rd Bolivar TN 38008-1532 |
| Mailing Address |
6625 Lenox Park Blvd. Suite 200 Memphis TN 38115 |
| Practice Telephone | 7316585207 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2019-12-06 |
| Authorized Official Name | RAHUL KULKARNI (SVP OF FINANCE) |
| Authorized Official Telephone | 8003747417 |
| Is Organization Subpart | Y |
| Parent Organization Name | FREDS INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Hudson Drug Store #3579 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770906737 | Freds Stores of Tennessee Inc. | Pharmacy | 808 Nc Highway 69, Hayesville, NC 28904-9696 | 2014-01-28 |
| 1275963753 | Freds Stores of Tennessee Inc. | Pharmacy | 418 A West Central Avenue, Jamestown, TN 38556 | 2013-11-19 |
| 1548602758 | Freds Stores of Tennessee Inc. | Pharmacy | 11858 S Main St, Trenton, GA 30752 | 2013-07-29 |
| 1043659394 | Freds Stores of Tennessee Inc. | Pharmacy | 2110 Goodman Rd E, Southaven, MS 38672-9006 | 2013-06-20 |
| 1285970988 | Freds Stores of Tennessee Inc. | Pharmacy | 5751 Shed Rd, Bossier City, LA 71111 | 2012-12-27 |
| 1447524145 | Freds Stores of Tennessee Inc. | Pharmacy | 400 W. Mckinley Ave., Haughton, LA 71037-9449 | 2012-02-28 |
| 1255609871 | Freds Stores of Tennessee Inc. | Pharmacy | 21361 Whyte Hardee Blvd., Hardeeville, SC 29927 | 2011-12-09 |
| 1790053502 | Freds Stores of Tennessee Inc. | Pharmacy | 652 Hwy 365, Mayflower, AR 72106 | 2011-12-07 |
| 1013299080 | Freds Stores of Tennessee Inc. | Pharmacy | 306 Lamar St, Kilmichael, MS 39747-9732 | 2011-09-15 |
| 1588061394 | Freds Stores of Tennessee Inc. | Pharmacy | 214 S Main St, Fairmont, NC 28340-1904 | 2014-11-21 |
| Street Address |
600 NUCKOLLS RD |
| City | BOLIVAR |
| State | TN |
| Zip Code | 38008-1532 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437160082 | Nuckolls Drug Stores, Inc | Pharmacy | 600 Nuckolls Rd, Bolivar, TN 38008-2393 | 2006-08-10 |
| 1730724493 | Hudson Drug Store, LLC | Pharmacy | 600 Nuckolls Rd, Bolivar, TN 38008-1532 | 2019-11-16 |
| 1306212162 | Jason Carter | Pharmacist | 600 Nuckolls Rd, Bolivar, TN 38008-1532 | 2015-08-17 |
| 1043363484 | James Kim Nuckolls | Pharmacist | 600 Nuckolls Rd, Bolivar, TN 38008-1532 | 2007-01-19 |
| 1427109834 | Amanda B Baker | Pharmacist | 600 Nuckolls Rd, Bolivar, TN 38008-1532 | 2007-01-13 |
| 1881745297 | Freeman Hunter Baird Jr. | Pharmacist | 600 Nuckolls Rd, Bolivar, TN 38008-1532 | 2007-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720639172 | Shanna Shackelford | Nurse Practitioner | 11100 Old Hwy 64 W, Bolivar, TN 38008 | 2019-09-26 |
| 1598326233 | Holly Brooke Shourd | Family Medicine | 1359 W Market St., Bolivar, TN 38008 | 2019-06-24 |
| 1992299234 | Angela Dawn Haynes | Registered Nurse | 10825 Hwy 64w, Bolivar, TN 38008 | 2018-06-20 |
| 1326595919 | Ashley Evon Jowers | Nurse Practitioner | 11100 Old Hwy 64 West, Bolivar, TN 38008 | 2016-09-01 |
| 1942458344 | Anita Pearl Johnson | Physical Therapy Assistant | 700 Knuckolls Ave, Bolivar, TN 38008 | 2008-08-28 |
| 1841340007 | State of Tennessee | Public Health or Welfare | 10825 Old Hwy 64, Bolivar, TN 38008 | 2007-01-11 |
| 1164479721 | Betty Ragon Lenoir | Physical Therapist | 789 Tennessee St, Bolivar, TN 38008 | 2006-05-28 |
| 1689623050 | County of Hardeman | Ambulance | 735 Naylor St, Bolivar, TN 38008 | 2006-05-10 |
| 1841287109 | Michiel Brent Rudder | Family Medicine | 622 West Market Street, Bolivar, TN 38008 | 2005-10-03 |
| 1982606497 | Richard Mast Reinhard IIi | Pediatrics | 629 Nuckolls Rd, Bolivar, TN 38008 | 2005-08-15 |
| Find all providers in zip 38008 | ||||
| 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 |
|---|---|---|---|---|
| 1467637868 | Walgreen Co | Pharmacy | 1820 S Springfield Ave, Bolivar, MO 65613-2563 | 2008-01-03 |
| 1437160082 | Nuckolls Drug Stores, Inc | Pharmacy | 600 Nuckolls Rd, Bolivar, TN 38008-2393 | 2006-08-10 |
| 1235144148 | The Tamarkin Company | Pharmacy | 11031 State Route 212 Ne, Bolivar, OH 44612-8744 | 2006-07-29 |
| 1730724493 | Hudson Drug Store, LLC | Pharmacy | 600 Nuckolls Rd, Bolivar, TN 38008-1532 | 2019-11-16 |
| 1013068220 | Nuckolls Drug Stores, Inc | Pharmacy | 407 W Lafayette St, Bolivar, TN 38008-2651 | 2007-01-15 |
| 1851495451 | Express Save-on Drugs LLC | Pharmacy | 622 W Market St, Bolivar, TN 38008-2241 | 2006-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033718317 | Rockvegas Enterprises Inc Dba Gateway Pharmacy | Pharmacy | 524 N Gateway Ave, Rockwood, TN 37854-2353 | 2020-10-19 |
| 1124626767 | Knoxville Rx Corp | Pharmacy | 10205 Kingston Pike Ste E, Knoxville, TN 37922-3285 | 2020-10-15 |
| 1073126181 | Off Center, LLC | Pharmacy | 910 Overton Plz, Livingston, TN 38570-1753 | 2020-08-28 |
| 1316557937 | Guardian Pharmacy of Tennessee Three, LLC | Pharmacy | 661 E Lane St Ste B, Shelbyville, TN 37160-3437 | 2020-08-07 |
| 1447860507 | Fph LLC | Pharmacy | 2200 N Central Ave, Humbolt, TN 38343 | 2020-08-04 |
| 1366069965 | Plaza Pharmacy LLC | Pharmacy | 3024 Covington Pike Ste 5, Memphis, TN 38128-5043 | 2020-06-30 |
| 1548886104 | Tumlin Rx, LLC | Pharmacy | 104 E Main Blvd, Church Hill, TN 37642-3724 | 2020-06-19 |
| 1366065278 | Life Well Pharmacy, LLC | Pharmacy | 2408 Susannah St Ste 3, Johnson City, TN 37601-1765 | 2020-05-27 |
| 1699398602 | Walgreen Co | Pharmacy | 262 Danny Thomas Pl Ste 100rx, Memphis, TN 38105-3678 | 2020-05-26 |
| 1053931881 | Jones & Joslin, Pllc | Pharmacy | 4249 Highway 411 Ste 5, Madisonville, TN 37354-1544 | 2020-04-22 |
| Find all providers with the same taxonomy | ||||
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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.