Organization
FRED MEYER STORES INC
Active
Other names
FRED MEYER PHARMACY #653
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
1501 E PARKS HWY, WASILLA, AK 99654-8283
(907) 352-5033
(907) 352-5027
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
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AK392
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021541
—
AK
01
—
1996882
PK
—
05
—
PH0302
—
AK
Enumeration date
06/18/2006
Last updated
10/14/2020
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