NPIMap

Organization Active NPI

Fred Meyer Pharmacy

  • Clinical Medical Laboratory
  • Portland, OR
National Provider Identifier
1619385259
Registry record updated Jul 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
RPH-0014163 Issued in OR
Legal business name
FRED MEYER PHARMACY
Practice address
3030 NE Weidler St
Portland, OR 97232-1851
Phone
(503) 280-1333
Fax
(503) 233-1327
NPI assigned
Jul 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2014

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

Authorized official

Name
Joel R Coffey
Title
Pharmacy Manager
Phone
(503) 280-1333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X RPH-0014163 OR Primary

Addresses

Primary practice location

3030 NE Weidler St
Portland, OR 97232-1851

Mailing address

3030 NE Weidler St
Portland, OR 97232-1851
Phone (503) 280-1333

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
38D0971561Fred Meyer Pharmacy #6003030 NE Weidler, Portland, OR 97232Certificate of waiverMar 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Fred Meyer Pharmacy174 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

3030 NE Weidler St
Portland, OR 97232
Phone (503) 280-1333

NPI Registry JSON

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

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406505600000",
    "number": "1619385259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 NE WEIDLER ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321851",
            "telephone_number": "503-280-1333",
            "fax_number": "503-233-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 NE WEIDLER ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321851",
            "telephone_number": "503-280-1333",
            "fax_number": "503-233-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-28",
        "last_updated": "2014-07-28",
        "status": "A",
        "authorized_official_last_name": "COFFEY",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "503-280-1333"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OR",
            "license": "RPH-0014163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.