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
800 YELLOWSTONE AVE, POCATELLO, ID 83201-4433
(208) 239-4033
(208) 239-4027
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1292RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002963800
—
ID
01
—
2020116
PK
—
Enumeration date
06/18/2006
Last updated
08/12/2016
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