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FRED MEYER STORES INC
>> Durable Medical Equipment & Medical Supplies >> SuppliersRegistrant NPI Number: 1013952548
Organizational Registrant:Organization Name: FRED MEYER STORES INC
Organization is not Subpart
Authorized Official: ALLISON MUENNICH MANAGER OF PHARMACY LICENSING 513--76-21019
Organization is not Subpart
Authorized Official: ALLISON MUENNICH MANAGER OF PHARMACY LICENSING 513--76-21019
Location and contact information for practice:
13401 OLD GLENN HWY EAGLE RIVER, AK 99577-7565 US
Tel: 907-689-4033 Fax: 907-689-4027
Tel: 907-689-4033 Fax: 907-689-4027
Contact information for business:
PO BOX 842772 BOSTON, MA 02284-2772 US
Tel: 513-762-1019 Fax: 513-762-1092
Tel: 513-762-1019 Fax: 513-762-1092
Registration Information:
NPI: 1013952548
Entity Type: Organization
Entity Type: Organization
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 332B00000X | Suppliers Durable Medical Equipment & Medical Supplies | ||
| N | 333600000X | Suppliers Pharmacy | ||
| N | 3336C0002X | Suppliers Pharmacy | ||
| Y | 3336C0003X | Suppliers Pharmacy | AK | AK384 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 1021572 | AK | 05 | |
| PK | 1997045 | 01 | |
| PH0668 | AK | 05 |
