Fred Meyer Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHAR.CF.00057554 Issued in WA

Legal business name

FRED MEYER STORES INC

Practice address

700 NE 87TH Ave
Suite 180
Vancouver, WA 98664-1913

Phone

(360) 882-2778

Fax

(360) 975-7733

NPI assigned

May 23, 2017

Organization subpart

No

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

Authorized official

Name

Karla Stone

Title

Pharmacy Credentialing Manager

Phone

(513) 698-1878

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Fred Meyer Pharmacy #069 Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

CLIA laboratory certificates

Member of 1

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

• The Kroger Co

  • Community/Retail Pharmacy
  • Woodstock, GA
  • NPI 1720012560

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1174051023",
    "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": "513-698-1878",
            "fax_number": "513-698-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE 87TH AVE",
            "address_2": "SUITE 180",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641913",
            "telephone_number": "360-882-2778",
            "fax_number": "360-975-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-23",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "PHARMACY CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "513-698-1878"
    },
    "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": "WA",
            "license": "PHAR.CF.00057554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2085027",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2169482",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fred Meyer Pharmacy #069",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Diane M. Z. Frazier, M.S.,CCC
• Jaydon Frazier
• Kelsey Rae Frazier, CCC-SLP
• Megan Rose Frazier, COTA
• Fred Meyer Stores Inc
• Fred Meyer Stores Inc
• Fred Meyer Stores Inc
• Fred Meyer Stores Inc
• Fred Meyer Stores Inc
• Fred Meyer Stores Inc

• Community/Retail Pharmacy in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.