Organization
FRED MEYER STORES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
944 SW 9TH ST, REDMOND, OR 97756
(541) 504-5133
(541) 504-5127
Mailing address
P.O. BOX 842772, BOSTON, MA 02284
(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
RP0001752CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001752
—
OR
05
—
019848
—
OR
01
—
2079037
PK
—
Enumeration date
06/20/2006
Last updated
04/20/2018
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