Fred Meyer Stores Inc
Organization Active NPI Community/Retail Pharmacy · Spanaway, WA
NPI 1679518013 · NPPES record last updated Jun 29, 2016
Key facts
- NPI
- 1679518013
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- CF00057636 (WA)
- Legal business name
- FRED MEYER STORES INC
- Practice address
- 22303 Mountain View Highway East
Spanaway, WA 98387 - Phone
- (253) 875-4033
- Fax
- (253) 875-4042
- NPI assigned
- Jun 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 24
Member of 1
Practitioners 3
-
Edward Anderson, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D1015767 | Fred Meyer Pharmacy #00604 | Certificate of waiver | Apr 4, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Fred Meyer Pharmacy #604 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040220000567 | WA | Part B Supplier - Mass Immunization (Roster Biller Only) | 1254234586 | This NPI is an additional NPI on the enrollment |
| O20100930059262 | WA | DME Supplier - Pharmacy |
1254234586 | Practice locations: Spanaway, WA |
National Provider Directory
- Tax ID family
- Fred Meyer Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | CF00057636 | WA | Yes |
Addresses
Primary practice location
22303 Mountain View Highway East
Spanaway, WA 98387
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2108079 | Other | PK | |
| 6026827 | Medicaid | WA |
Other names
- FRED MEYER PHARMACY
Other providers in Spanaway, WA
- Footprints Applied Behavior Analysis LLC
- Monica Forman-Mason
- Dawn Fox
- Oksana Frair
- Franciscan Medical Group
- Belinda Maureen Frederick
- Penny Friedman
- Michael J Frink
- Ginger Frisk
- Dawn Frye
All providers in Spanaway, WA · Community/Retail Pharmacy in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.