# FRED MEYER STORES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FRED MEYER PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811932981
- **Authorized official:** ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
- **Authorized official phone:** (513) 762-1019

## Contact information

- **Practice address:** 6850 N LOMBARD ST, PORTLAND, OR 97203-6247
- **Practice address phone:** (503) 286-0629
- **Practice address fax:** (503) 240-2724
- **Mailing address:** PO BOX 842772, BOSTON, MA 02284-2772
- **Mailing address phone:** (513) 762-1019
- **Mailing address fax:** (513) 762-1092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP0000060CS | OR | Yes |

## Other

- **Enumeration date:** 06/20/2006
- **Last updated:** 06/29/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 064196 | — | OR |
| 01 | — | 2077381 | PK | — |