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Contact Information

FRED MEYER STORES INC
3755 AIRPORT WAY
FAIRBANKS, AK99709-4610
 Phone: 907-474-1433
 Fax: 907-474-1447
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Clinic Pharmacy

3336C0002X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for FRED MEYER STORES INC

NPI # 1508802059
LBN Legal business name FRED MEYER STORES INC
Authorized official ALLISON MUENNICH - (MANAGER OF PHARMACY LICENSING)
Entity Organization
Organization subpart 1 No
Enumeration date 06/22/2006
Last updated 10/14/2020 - About 6 years ago
Identifiers
AK License # AK391
AK Medicaid 1021555
AK Medicaid MS0712
AK Medicaid PH0712
Other 1996601 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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