Organization
FRED MEYER STORES INC
Active
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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