Organization
FRED MEYER STORES INC
Active
Other names
FRED MEYER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MINEER (INTERFACE MANAGER)
(513) 387-7074
Entity
Organization
Contact information
Practice address
525 E FRANCIS AVE, SPOKANE, WA 99208-1039
(509) 489-2085
(509) 489-0248
Mailing address
3800 SE 22ND AVE, PORTLAND, OR 97202-2918
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00002210
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4908957
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6029409
—
WA
Enumeration date
06/23/2006
Last updated
04/23/2012
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