Provider Information for 1104861632
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FRED MEYER STORES INC
Other Names:Doing Business As:FRED MEYER PHARMACYOrganization Subpart: NO
NPI: 1104861632
Last Updated: 2020-10-14
Certification Date: 2020-10-14
Certification Date: 2020-10-14
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1104861632 | ||||||||||||||||||||
| Enumeration Date | 2006-06-18 | ||||||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Authorized Official Information | Name: ALLISON MUENNICH Title: MANAGER OF PHARMACY LICENSING Phone: 5137621019 | ||||||||||||||||||||
| Mailing Address | PO BOX 842772 BOSTON, MA 02284-2772 United States Phone: 513-762-1019 | Fax:513-762-1092 | ||||||||||||||||||||
| Primary Practice Address | 2300 ABBOTT RD ANCHORAGE, AK 99507-4456 United States Phone: 907-365-2033 | Fax:907-365-2027 | ||||||||||||||||||||
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