Active NPI
Fred Meyer Stores Inc
- Community/Retail Pharmacy
- Twin Falls, ID
National Provider Identifier
1043256951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1293RP
- Legal business name
- FRED MEYER STORES INC
- Doing business as
- FRED MEYER PHARMACY
- Practice address
- 705 Blue Lakes Blvd N
Twin Falls, ID 83301-4007 - Phone
- (208) 736-5373
- Fax
- (208) 736-5367
- NPI assigned
- Jun 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1293RP | ID | Primary |
Addresses
Primary practice location
705 Blue Lakes Blvd N
Twin Falls, ID 83301-4007
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003406400 | Medicaid | ID | |
| 2021431 | Other | PK |
Other names 1
- FRED MEYER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091006000210 | ID | Part B Supplier - Mass Immunization (Roster Biller Only) | 1254234586 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Meridian, ID; Twin Falls, ID; Pocatello, ID; Nampa, ID; Garden City, ID; Boise, ID; Coeur D Alene, ID; Idaho Falls, ID |
| O20100930077027 | ID | DME Supplier - Pharmacy | 1254234586 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
| O20100930089599 | ID | DME Supplier - Pharmacy | 1254234586 | Practice locations: Twin Falls, ID |
Other NPIs on the same Medicare enrollment 10
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community/Retail Pharmacy
- Boise, ID
- NPI 1134165046
O20091006000210, O20100930077027
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Fred Meyer Pharmacy #383 | Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… | Accepts assignment |
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1470960000000",
"number": "1043256951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 842772",
"city": "BOSTON",
"state": "MA",
"postal_code": "022842772",
"telephone_number": "513-762-1019",
"fax_number": "513-762-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 BLUE LAKES BLVD N",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833014007",
"telephone_number": "208-736-5373",
"fax_number": "208-736-5367"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRED MEYER STORES INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-20",
"last_updated": "2016-08-12",
"status": "A",
"authorized_official_last_name": "MUENNICH",
"authorized_official_first_name": "ALLISON",
"authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
"authorized_official_telephone_number": "513-762-1019"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "ID",
"license": "1293RP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003406400",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2021431",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FRED MEYER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.