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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
1333600000XPharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0003XCommunity/Retail Pharmacy1299RPID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22020628OTHERPK

General Provider Information

NPI Number : 1316983224
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 : 5425 W CHINDEN BLVD
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-1468
Country : US
Telephone Number : 208-323-7036
Fax Number : 208-323-7033
Authorized Official
Title or Position : MANAGER OF PHARMACY LICENSING
Name : ALLISON MUENNICH
Credential :
Telephone Number : 513-762-1019
Provider Enumeration Date : 06/20/2006
Last Update Date : 08/12/2016

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Directions to “FRED MEYER STORES INC ” Practice Location

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