Organization
FRED MEYER STORES INC
Active
Other names
Fred Meyer Pharmacy #069
Organization subpart
No
Provider details
NPI number
Authorized official
KARLA STONE (PHARMACY CREDENTIALING MANAGER)
(513) 698-1878
Entity
Organization
Contact information
Practice address
700 NE 87TH AVE, SUITE 180, VANCOUVER, WA 98664-1913
(360) 882-2778
(360) 975-7733
Mailing address
1014 VINE ST, CINCINNATI, OH 45202-1141
(513) 698-1878
(513) 698-1997
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.00057554
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2085027
—
WA
01
—
2169482
PK
—
Enumeration date
05/23/2017
Last updated
04/22/2025
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