Organization
FRED MEYER STORES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
1020 S FIRST AVENUE, COOS BAY, OR 97420
(541) 269-4033
(541) 269-4034
Mailing address
P.O. BOX 842772, BOSTON, MA 02284
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP0000926CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182555
—
OR
01
—
2077890
PK
—
05
—
209189
—
OR
Enumeration date
06/23/2006
Last updated
04/20/2018
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