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
7555 SW BARBUR BLVD, PORTLAND, OR 97219-3090
(503) 452-3033
(503) 452-3027
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP0000052CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064113
—
OR
01
—
2077377
PK
—
Enumeration date
06/21/2006
Last updated
06/29/2016
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