FREDS STORES OF TENNESSEE INC (NPI# 1831116300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831116300 |
| Entity Type | Organization |
| Organization Name | FREDS STORES OF TENNESSEE INC |
| Other Organization Name | FREDS PHARMACY 1929 |
| Practice Address |
14916 Hwy 16 West Dekalb MS 39328 |
| Mailing Address |
6625 Lenox Park Blvd. Suite 200 Memphis TN 38115 |
| Practice Telephone | 6017432917 |
| Practice Fax Number | 6017434455 |
| Mailing Telephone | 9012382520 |
| Mailing Fax Number | 9013659820 |
| Enumeration Date | 2006-07-17 |
| 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 | 6638011 | MS | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
6638011 | MS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 2586456 | 01 | |
| MS | 9001285 | 05 |
| Other Name | Type Code |
|---|---|
| FREDS Pharmacy 1929 | 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 |
14916 HWY 16 WEST |
| City | DEKALB |
| State | MS |
| Zip Code | 39328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700303104 | James Waldo Vandevender | Pharmacist | 14916 Hwy 16 West, Dekalb, MS 39328 | 2017-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194342592 | Tashanda Chamberlin | Respite Care | 100 Hopper Ave, Dekalb, MS 39328 | 2020-07-01 |
| 1285270801 | Proxsys Rx - Rush LLC | Pharmacy | 14916 Hwy 16 W, Unit #1, Dekalb, MS 39328 | 2019-11-19 |
| 1992191084 | Emmanuel Ridge of Dekalb Inc | Registered Nurse | 14632 Hwy 39n/16e, Dekalb, MS 39328 | 2015-04-15 |
| 1376978551 | Bio-medical Applications of Mississippi, Inc. | Clinic/Center | 30 Ponderosa Avenue, Dekalb, MS 39328 | 2013-09-06 |
| 1386729580 | Darrell J Zehr | Dentist | 201 Birch Street, Dekalb, MS 39328 | 2006-10-26 |
| 1225148158 | Daniel Elliot Fulton Jr. | Dentist | Hwy 39 S Church Street, Dexalb, MS 39328 | 2006-08-30 |
| 1467072165 | Haley Ezelle | Occupational Therapist | 220 Willow Ave, Dekalb, MS 39328 | 2020-04-22 |
| 1609866235 | Kemper County Ltc Inc | Skilled Nursing Facility | 220 Willow Ave, Dekalb, MS 39328-0577 | 2005-10-25 |
| 1558601609 | Annetta Merideth | Massage Therapist | 16657 Highway 16 E, De Kalb, MS 39328-5511 | 2013-02-27 |
| 1144494022 | Obp Homemaker Services, Inc. | Preferred Provider Organization | 931 Frank Mcdaniel Rd, De Kalb, MS 39328-7653 | 2008-04-22 |
| Find all providers in zip 39328 | ||||
| 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 |
|---|---|---|---|---|
| 1285270801 | Proxsys Rx - Rush LLC | Pharmacy | 14916 Hwy 16 W, Unit #1, Dekalb, MS 39328 | 2019-11-19 |
| 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 |
| 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 |
| 1588215040 | Scpg Mississippi LLC | Pharmacy | 1068 Hwy 61 N, Tunica, MS 38676 | 2019-09-26 |
| 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.