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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