# FRED MEYER STORES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fred Meyer Pharmacy \#694
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629528344
- **Authorized official:** ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
- **Authorized official phone:** (513) 762-1263

## Contact information

- **Practice address:** 17005 SE SUNNYSIDE RD, HAPPY VALLEY, OR 97015-8724
- **Practice address phone:** (971) 999-6284
- **Practice address fax:** (971) 999-6283
- **Mailing address:** PO BOX 842772, BOSTON, MA 02284-2772
- **Mailing address phone:** (513) 762-1019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0003223 | OR | Yes |

## Other

- **Enumeration date:** 10/05/2016
- **Last updated:** 01/17/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1629528344 | — | OR |
| 01 | — | 2164634 | PK | — |