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
20904 HWY 410, BONNEY LAKE, WA 98390
(253) 891-7333
(253) 891-7327
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
CF00004938
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109687
PK
—
05
—
6014369
—
WA
Enumeration date
06/24/2006
Last updated
06/29/2016
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