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General NPI Number Information
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NPI Number | 1558295386
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Entity Type | Organization
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Legal Business Name | FRED MEYER STORES INC
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 8421 SE 68TH ST
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City | MERCER ISLAND
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State | WA
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Zip | 98040-5235
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Country | US
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Telephone | 206-494-0871
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Fax | 206-962-3588
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Provider Business Mailing Address
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Address Line | PO BOX 830242
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City | PHILADELPHIA
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State | PA
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Zip | 19183-0352
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Country | US
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Telephone | 513-762-1090
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Fax |
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Authorized Official
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Title or Position | MANAGER OF LICENSING
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Name | LYSETTE SEILHAMER
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Credential |
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Telephone | 513-587-5328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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