FREDS STORES OF TENNESSEE INC (NPI# 1629000567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629000567 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 1321 |
| Practice Address |
195 North 641 Camden TN 38320 |
| Mailing Address |
6625 Lenox Park Blvd. Suite 200 Memphis TN 38115 |
| Practice Telephone | 7315847595 |
| Practice Fax Number | 7315840779 |
| 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 | C2894 | TN | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
C2894 | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 9449861 | 05 | |
| OTHER ID NUMBER-COMMERCIAL NUMBER | 4427882 | 01 |
| Other Name | Type Code |
|---|---|
| FREDS PHARMACY 1321 | 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 |
195 NORTH 641 |
| City | CAMDEN |
| State | TN |
| Zip Code | 38320 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144525395 | Mickie Carter | Physician Assistant | 284 Hwy 641 N, Camden, TN 38320 | 2011-01-19 |
| 1447574249 | Virginia Margarita Peebles | Nurse Practitioner | 176 Briarwood Ave, Suite B, Camden, TN 38320 | 2010-03-23 |
| 1194857417 | Tron D Baker | Case Manager/Care Coordinator | 495 Liberty Rod, Camden, TN 38320 | 2007-03-12 |
| 1801968854 | Michael Eugene Bogard | Physical Therapist | 77 East Lake St, Camden, TN 38320 | 2006-11-14 |
| 1134217029 | Agustin V Vitualla | General Practice | 135 Hospital Dr, Camden, TN 38320 | 2006-10-10 |
| 1215995287 | Quality Home Health Care, Inc. | Home Health | 279 W Main St, Camden, TN 38320 | 2006-05-01 |
| 1285612564 | Camden Medical Clinic, Inc | Clinic/Center | 160 Hospital Dr., Camden, TN 38320 | 2006-01-06 |
| 1073513636 | William Hall Mcconnell | Optometrist | 194 W. Main St., Camden, TN 38320 | 2005-07-26 |
| 1790077139 | Ccc Medical Equipment Inc | Durable Medical Equipment & Medical Supplies | 115 Vicksburg Ave, Camden, TN 38320 | 2011-05-04 |
| 1730240441 | State of Tennessee | Public Health or Welfare | 225 Hospital Drive, Camden, TN 38320 | 2006-12-13 |
| Find all providers in zip 38320 | ||||
| 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 |
|---|---|---|---|---|
| 1881233146 | Santram Health LLC | Pharmacy | 4598 S Dupont Hwy, Camden, DE 19934-1380 | 2020-01-03 |
| 1427604578 | Superdrug Pharmacy Inc | Pharmacy | 1492 Mount Ephraim Ave, Camden, NJ 08104-1550 | 2019-08-14 |
| 1992049126 | Rivercare Solutions LLC | Pharmacy | 3213 River Rd, Camden, NJ 08105-4215 | 2012-11-09 |
| 1215241393 | Raghu Ram Inc | Pharmacy | 3703 Westfield Ave, Camden, NJ 08105 | 2010-08-02 |
| 1760525489 | Rxd Pharmacy of Nj Inc | Pharmacy | 1805 Broadway, A&b Drugs, Camden, NJ 08102 | 2007-02-14 |
| 1114060829 | Rxd Pharmacy of Nj Inc | Pharmacy | 617 Broadway Ave, Ellis Drugs, Camden, NJ 08103 | 2007-02-14 |
| 1093864654 | Eureka Drug Stores, Inc. | Pharmacy | 1032 Broad St, Camden, SC 29020-4308 | 2007-01-10 |
| 1659444297 | Micrimar Inc | Pharmacy | 221 S Broadway, Camden, NJ 08103-1287 | 2006-11-15 |
| 1437229713 | Medsinbox Ltc LLC | Pharmacy | 2319 Federal St, Camden, NJ 08105-1929 | 2006-11-08 |
| 1336235902 | Jayhawk Holdings Inc | Pharmacy | 2626 Federal St, Camden, NJ 08105-1936 | 2006-10-04 |
| Find all providers in CAMDEN | ||||
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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.