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Organization

FRED MEYER STORES INC

Active
Other names
Fred Meyer Pharmacy #694
Organization subpart
No

Provider details

NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization

Contact information

Practice address
17005 SE SUNNYSIDE RD, HAPPY VALLEY, OR 97015-8724
(971) 999-6284
(971) 999-6283
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
RP-0003223
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1629528344
OR
01
2164634
PK
Enumeration date
10/05/2016
Last updated
01/17/2017
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