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FREDS STORES OF TENNESSEE INC NPI 1477585412


NPI Information

NPI: 1477585412
Provider Name: FREDS STORES OF TENNESSEE INC

Doing Business As: FREDS PHARMACY 1516

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
1021 US HIGHWAY 45 N
ELDORADO, IL
ZIP 62930
Phone: (618) 273-3874
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FREDS STORES OF TENNESSEE INC is a community/retail pharmacy pharmacy in Eldorado, IL. The provider is 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. FREDS STORES OF TENNESSEE INC NPI is 1477585412. The provider is registered as an organization entity type.
The provider Is Doing Business As Freds Pharmacy 1516.

The provider's business location address is:

1021 US HIGHWAY 45 N
ELDORADO, IL
ZIP 62930-767
Phone: (618) 273-3874
Fax: (618) 273-3843

The provider's authorized official is Ricky Chambers .
The authorized official title is Vp and has the following contact phone number (901) 238-2477.

The enumeration date for this NPI number is 7/7/2006 and was last updated on 11/5/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacy54014867ILLINOISNo
23336C0003XPharmacyCommunity/Retail Pharmacy54014867ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10537670212MEDICARE NSC
21475436OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3=========003MEDICAIDILLINOIS
4IL7573MEDICARE PINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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