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Organization
FRED MEYER STORES INC
Active
Organization
FRED MEYER STORES INC
Active
Other names
FRED MEYER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
6615 NE GLISAN ST, PORTLAND, OR 97213-5068
(503) 797-6973
(503) 797-6967
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RP0000056CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064147
—
OR
01
—
2077375
PK
—
Enumeration date
06/20/2006
Last updated
06/29/2016
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