FREDS STORES OF TENNESSEE INC (NPI# 1710383690) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710383690 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 3966 |
| Practice Address |
810 Se Washington St Idabel OK 74745-3442 |
| Mailing Address |
6625 Lenox Park Blvd. Suite 200 Memphis TN 38115 |
| Practice Telephone | 5802082400 |
| Practice Fax Number | 5802082401 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2014-11-05 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200568060A | 05 |
| Other Name | Type Code |
|---|---|
| Freds Pharmacy 3966 | 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 |
| 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 |
| 1396176095 | Freds Stores of Tennessee Inc | Pharmacy | 93 Bushrod Johnson Ave, Chickamauga, GA 30707-6093 | 2013-12-05 |
| Street Address |
810 SE WASHINGTON ST |
| City | IDABEL |
| State | OK |
| Zip Code | 74745-3442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962053843 | Idabel Express Pharmacy, LLC | Durable Medical Equipment & Medical Supplies | 810 Se Washington St, Idabel, OK 74745-3332 | 2019-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568957348 | Home Run Healthcare | Family Medicine | 1425 East Lincoln Road, Suite A-3, Idabel, OK 74745 | 2018-06-25 |
| 1720457203 | Leann Tomlinson | Registered Nurse | 2002 E Lincoln Rd, Idabel, OK 74745 | 2015-09-15 |
| 1659795508 | Laura Rush | Optometrist | 902 Lincoln Road, Idabel, OK 74745 | 2014-02-13 |
| 1619301116 | White River Home Health | Home Health | 2100 East Washington Street Ste D, Idabel, OK 74745 | 2013-09-03 |
| 1922440999 | John Phillip Stone Scoggin | Counselor | 111 Canterbury Lane, Idabel, OK 74745 | 2013-07-19 |
| 1841576725 | Ayesha Shante Wyatt | Nurse's Aide | 1800 Hillcrest, Idabel, OK 74745 | 2011-10-24 |
| 1154569457 | Southern Oklahoma Treatment Services, Inc. | Community/Behavioral Health | 6 Southeast Avenue A, Idabel, OK 74745 | 2009-01-26 |
| 1417103854 | John Hoskins | Internal Medicine | 902 Lincoln Rd, Choctaw Nation Health Clinic, Idabel, OK 74745 | 2008-08-18 |
| 1801077045 | Rhonda Cheryl Rodgers | Counselor | 104 Ne Ave A, Idabel, OK 74745 | 2007-11-15 |
| 1326241548 | Beverly Gayle Jasper-hayes | Counselor | 104 Ne A - Avenue, Idabel, OK 74745 | 2007-06-06 |
| Find all providers in zip 74745 | ||||
| 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] |
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|---|---|---|---|---|
| 1558968958 | Westville Drug Company LLC | Pharmacy | 301 S. Williams St, Westville, OK 74965-7496 | 2020-10-08 |
| 1245843796 | Creek Nation Hospital & Clinics | Pharmacy | 1000 Riverwalk Ter, Jenks, OK 74037-5666 | 2020-08-25 |
| 1104451095 | Oklahoma Specialty Pharmacy,llc | Pharmacy | 13921 N Meridian Ave Ste 102, Oklahoma City, OK 73134-1103 | 2020-03-11 |
| 1437797248 | Oxford Pharmacy LLC | Pharmacy | 6001 S Sooner Rd Ste B, Oklahoma City, OK 73135-5601 | 2019-12-12 |
| 1952946022 | The Children's Center, Inc. | Pharmacy | 6770 Nw 39th Expy, Bethany, OK 73008-2646 | 2019-11-13 |
| 1174179154 | Lone Grove Pharmacy LLC | Pharmacy | 45 Almond Dr, Ardmore, OK 73401-2405 | 2019-08-14 |
| 1063068385 | Murray Drug Co. LLC | Pharmacy | 316 North Main St, Granite, OK 73547 | 2019-08-13 |
| 1962063933 | Walgreen Co | Pharmacy | 1145 S Utica Ave Ste G1, Tulsa, OK 74104-4022 | 2019-06-21 |
| 1760040943 | Neighborhood Pharmacy,llc | Pharmacy | 3122 N May Ave, Oklahoma City, OK 73112-6942 | 2019-06-03 |
| 1811553423 | Sequoyah County Drug Company Pllc | Pharmacy | 806 Campbell Rd Ste B, Warner, OK 74469-5008 | 2019-05-20 |
| 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.