Provider Demographics
NPI:1356373294
Name:FREDS OF PARSONS INC
Entity type:Organization
Organization Name:FREDS OF PARSONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-238-2477
Mailing Address - Street 1:501 TENNESSEE AVE N
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-2616
Mailing Address - Country:US
Mailing Address - Phone:731-847-3851
Mailing Address - Fax:731-847-2216
Practice Address - Street 1:501 TENNESSEE AVE N
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2616
Practice Address - Country:US
Practice Address - Phone:731-847-3851
Practice Address - Fax:731-847-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC2974333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4428896OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4428896OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1213950001Medicare NSC