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Contact Information

FRED MEYER STORES INC
20904 HWY 410
BONNEY LAKE, WA98390
 Phone: 253-891-7333
 Fax: 253-891-7327
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 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 # 1790711489
LBN Legal business name FRED MEYER STORES INC
Authorized official ALLISON MUENNICH - (MANAGER OF PHARMACY LICENSING)
Entity Organization
Organization subpart 1 No
Enumeration date 06/24/2006
Last updated 06/29/2016 - About 10 years ago
Identifiers
WA License # CF00004938
WA Medicaid 6014369
Other 2109687 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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