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NPI Code Detail

MEDICARE: FRED MEYER STORES INC

MEDICARE: FRED MEYER STORES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0003XCommunity/Retail PharmacyCF00002196WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22107649OTHERPK

General Provider Information

NPI Number : 1386687598
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRED MEYER STORES INC
Provider Business Mailing Address
First Line : P.O. BOX 842772
Second Line :
City : BOSTON
State : MA
Zip : 02284
Country : US
Telephone Number : 513-762-1019
Fax Number : 513-762-1092
Provider Business Practice Location Address
First Line : 25250 PACIFIC HWY S
Second Line :
City : KENT
State : WA
Zip : 98032-6539
Country : US
Telephone Number : 253-946-7433
Fax Number : 253-946-7427
Authorized Official
Title or Position : MANAGER OF PHARMACY LICENSING
Name : ALLISON MUENNICH
Credential :
Telephone Number : 513-762-1019
Provider Enumeration Date : 06/14/2006
Last Update Date : 09/19/2025

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Directions to “FRED MEYER STORES INC ” Practice Location

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