NPIMap

Organization Active NPI

Fred Meyer Stores Inc.

Doing business as QFC Pharmacy #837

  • Community/Retail Pharmacy
  • Maple Valley, WA
National Provider Identifier
1104676568
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
FRED MEYER STORES INC.
Doing business as
QFC Pharmacy #837
Practice address
22131 SE 237TH St
Maple Valley, WA 98038-8533
Phone
(425) 433-2078
Fax
(425) 358-5016
NPI assigned
Mar 26, 2024
Last updated
Mar 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victoria Bone
Title
Licensing Asp
Phone
(513) 246-3091

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

22131 SE 237TH St
Maple Valley, WA 98038-8533

Mailing address

1014 Vine St
Cincinnati, OH 45202-1141
Phone (513) 246-3091

Other names 1

  • QFC Pharmacy #837 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040220000567 WA Part B Supplier - Mass Immunization (Roster Biller Only) 1254234586 This NPI is an additional NPI on the enrollment
O20240624000819 WA DME Supplier - Pharmacy 1254234586 Practice locations: Maple Valley, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2305001QFC Pharmacy 705-83722131 SE 237TH St, Maple Valley, WA 98038Certificate of waiverApr 4, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
QFC Pharmacy #83722131 SE 237TH St, Maple Valley, WA 98038-8533(425) 433-2078 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 assignmentParticipating since Jul 1, 1966

National Provider Directory

National Provider Directory
Tax ID family
Fred Meyer Inc Og240174 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1104676568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 VINE ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452021141",
            "telephone_number": "513-246-3091",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22131 SE 237TH ST",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388533",
            "telephone_number": "425-433-2078",
            "fax_number": "425-358-5016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER STORES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "BONE",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "LICENSING ASP",
        "authorized_official_telephone_number": "513-246-3091"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QFC Pharmacy #837",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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.

Verify at the official NPI Registry.