# FRED MEYER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063897239
- **Authorized official:** LE KAY TRANG PHARMD (PHARMACIST GRADUATE INTERN)
- **Authorized official phone:** (503) 286-6784

## Contact information

- **Practice address:** 7404 N INTERSTATE AVE, PORTLAND, OR 97217-5528
- **Practice address phone:** (503) 286-6784
- **Practice address fax:** (503) 286-6792
- **Mailing address:** 7404 N INTERSTATE AVE, PORTLAND, OR 97217-5528
- **Mailing address phone:** (503) 286-6784
- **Mailing address fax:** (503) 286-6792

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 07/29/2015
- **Last updated:** 07/29/2015