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General NPI Number Information
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NPI Number | 1891030300
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Entity Type | Organization
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Legal Business Name | FRED MEYER PHARMACY
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 4505 SOUTH 19TH
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City | TACOMA
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State | WA
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Zip | 98405
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Country | US
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Telephone | 253-752-9110
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Fax | 253-756-9320
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Provider Business Mailing Address
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Address Line | 4505 SOUTH 19TH
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City | TACOMA
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State | WA
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Zip | 98405
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Country | US
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Telephone | 253-752-9110
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Fax | 253-756-9320
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. AMRO ABU HALLAWAH
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Credential | R.PH.
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Telephone | 253-752-9110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | PH00009951
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License Number State | WA
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