Healthcare Provider Details

I. General information

NPI: 1386687598
Provider Name (Legal Business Name): FRED MEYER STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25250 PACIFIC HWY S
KENT WA
98032-6539
US

IV. Provider business mailing address

P.O. BOX 842772
BOSTON MA
02284
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-7433
  • Fax: 253-946-7427
Mailing address:
  • Phone: 513-762-1019
  • Fax: 513-762-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00002196
License Number StateWA

VIII. Authorized Official

Name: ALLISON MUENNICH
Title or Position: MANAGER OF PHARMACY LICENSING
Credential:
Phone: 513-762-1019