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
705 BLUE LAKES BLVD N, TWIN FALLS, ID 83301-4007
(208) 736-5373
(208) 736-5367
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1293RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003406400
—
ID
01
—
2021431
PK
—
Enumeration date
06/20/2006
Last updated
08/12/2016
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