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
14700 SE DIVISION ST, PORTLAND, OR 97236-2335
(503) 762-4436
(503) 762-4430
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
RP0000054CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064139
—
OR
01
—
2077378
PK
—
Enumeration date
06/20/2006
Last updated
09/19/2025
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