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NPI Code Detail

MEDICARE: FRED MEYER STORES INC

MEDICARE: FRED MEYER STORES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyCF57439WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22107494OTHERPK

General Provider Information

NPI Number : 1134144777
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRED MEYER STORES INC
Provider Business Mailing Address
First Line : PO BOX 842772
Second Line :
City : BOSTON
State : MA
Zip : 02284-2772
Country : US
Telephone Number : 513-762-1019
Fax Number : 513-762-1092
Provider Business Practice Location Address
First Line : 3505 SE 192ND AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-1436
Country : US
Telephone Number : 360-253-3043
Fax Number : 360-253-3031
Authorized Official
Title or Position : MANAGER OF PHARMACY LICENSING
Name : ALLISON MUENNICH
Credential :
Telephone Number : 513-762-1019
Provider Enumeration Date : 07/13/2006
Last Update Date : 09/19/2025

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Directions to “FRED MEYER STORES INC ” Practice Location

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