Healthcare Provider Details

I. General information

NPI: 1205979572
Provider Name (Legal Business Name): FRED MEYER STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 4TH AVE
HUTCHINSON KS
67501-1903
US

IV. Provider business mailing address

PO BOX 2377 FREDMEYER PHARMACY
PORTLAND OR
97208-2377
US

V. Phone/Fax

Practice location:
  • Phone: 866-680-5133
  • Fax: 620-669-1898
Mailing address:
  • Phone: 866-680-5133
  • Fax: 620-669-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. WENDELL MARK WOOLF
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 513-762-4672