Healthcare Provider Details

I. General information

NPI: 1962326611
Provider Name (Legal Business Name): FRED MEYER STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 MUKILTEO SPEEDWAY
MUKILTEO WA
98275-5432
US

IV. Provider business mailing address

PO BOX 830242
PHILADELPHIA PA
19183-0352
US

V. Phone/Fax

Practice location:
  • Phone: 425-249-0334
  • Fax: 425-366-8072
Mailing address:
  • Phone: 513-762-1090
  • Fax:

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LYSETTE SEILHAMER
Title or Position: MANAGER OF LICENSING
Credential:
Phone: 513-587-5328