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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 PharmacyRP0000060CSOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12077381OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811932981
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 : 6850 N LOMBARD ST
Second Line :
City : PORTLAND
State : OR
Zip : 97203-6247
Country : US
Telephone Number : 503-286-0629
Fax Number : 503-240-2724
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 : 06/29/2016

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