Fred Meyer Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF00057697 Issued in WA

Legal business name

FRED MEYER STORES INC

Doing business as

QFC Pharmacy

Practice address

1600 W Dravus St
Seattle, WA 98119-1721

Phone

(206) 283-0366

Fax

(206) 283-2958

NPI assigned

Dec 29, 2006

Last updated

Jul 26, 2010By 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

Matt Mineer

Title

Interface Manager

Phone

(513) 387-7074

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• QFC PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280102400000",
    "number": "1689730046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10116 NE 8TH ST",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W DRAVUS ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981191721",
            "telephone_number": "206-283-0366",
            "fax_number": "206-283-2958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2010-07-26",
        "status": "A",
        "authorized_official_last_name": "MINEER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "INTERFACE MANAGER",
        "authorized_official_telephone_number": "513-387-7074"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00057697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6031181",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4930409",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QFC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fred Meyer Stores Inc (Fred Meyer Pharmacy)
• Fred Meyer Stores Inc (Fred Meyer Pharmacy)
• Fred Meyer Stores Inc (QFC Pharmacy)
• Fred Meyer Stores Inc (QFC Pharmacy #807)
• Fred Meyer Stores Inc (QFC Pharmacy)
• Fred Meyer Stores Inc (Fred Meyer Pharmacy)
• Fred Meyer Stores Inc. (QFC North Seattle)
• Fred Meyer Stores Inc. (QFC West Seattle #883)
• Fred S Hsu DMD PLLC
• Grace Fredeen, CO

• Community/Retail Pharmacy in Seattle, WA
• Providers in Seattle, 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 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.