Organization
FRED MEYER STORES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
2000 W DIMOND BLVD, ANCHORAGE, AK 99515
(907) 267-6733
(907) 267-6739
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
AK388
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021512
—
AK
01
—
1996699
PK
—
Enumeration date
06/20/2006
Last updated
10/14/2020
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