Fred Meyer Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60546634 Issued in WA

Legal business name

FRED MEYER PHARMACY

Practice address

301 E Wallace Kneeland Blvd
Shelton, WA 98584-2985

Phone

(702) 460-4364

NPI assigned

Jul 27, 2015

Last updated

Jul 27, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ivo Mirtchev, PHARMDNPI 1093187502

Title

Pharmacist

Phone

(702) 460-4364

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ivo Mirtchev, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Las Vegas, NV
  • NPI 1093187502
  Authorized official Same address or phone

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

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437955200000",
    "number": "1366827834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 15TH AVE UNIT 511",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981223981",
            "telephone_number": "702-460-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E WALLACE KNEELAND BLVD",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842985",
            "telephone_number": "702-460-4364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-27",
        "last_updated": "2015-07-27",
        "status": "A",
        "authorized_official_last_name": "MIRTCHEV",
        "authorized_official_first_name": "IVO",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "702-460-4364",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "60546634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dolores Mae Fraire, OD
• Rebecca Ann Fraley
• Diana Jean Franckowiak, PTA
• Denise Marie Frank, RN
• Lynette Rachelle Frantzen, PHD, LMHC,LPC-S, NCC
• Fred Meyer Stores Inc (Fred Meyer Pharmacy)
• Suzanna Louise Fuentes, LMP
• Sarah Fulkerson
• Gregory Alan Fulling, MS PT
• Joy Fulling

• Community/Retail Pharmacy in Shelton, WA
• Providers in Shelton, 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 Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.