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Contact Information

FREDS STORES OF TENNESSEE INC
218 20 S WHITWORTH
BROOKHAVEN, MS39601
 Phone: 601-835-0370
 Fax: 601-835-3376
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for FREDS STORES OF TENNESSEE INC

NPI Number 1053343095
LBN Legal business name FREDS STORES OF TENNESSEE INC
Authorized official RICK CHAMBERS - (VP)
Entity Organization
Organization subpart 1 Yes
Enumeration date 07/07/2006
Last updated 03/09/2012 - About 14 years ago
Identifiers
MS License # 23821FB
MS Medicaid 08105813
Other 2517487 OTHER ID NUMBER-COMMERCIAL NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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