# FRED MEYER PHARMACY

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

## Provider details

- **NPI number:** 1245781574
- **Authorized official:** DR. JOANNE LOUISE KREUZER PHARM. D. (REGISTERED PHARMACIST)
- **Authorized official phone:** 12087365373

## Contact information

- **Practice address:** 705 BLUE LAKES BLVD N, TWIN FALLS, ID 83301-4007
- **Practice address phone:** (120) 873-6537
- **Mailing address:** 705 BLUE LAKES BLVD N, TWIN FALLS, ID 83301-4007
- **Mailing address phone:** (120) 873-6537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | P5593 | ID | Yes |

## Other

- **Enumeration date:** 10/21/2016
- **Last updated:** 10/21/2016