Fred Meyer Stores Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF59062 Issued in WA

Legal business name

FRED MEYER STORES INC

Practice address

17411 SE 272ND St
Covington, WA 98042-5311

Phone

(253) 631-1200

Fax

(253) 631-7147

NPI assigned

May 1, 2007

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 1

Addresses

Other identifiers 2

Other names 1

• QFC PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247529600000",
    "number": "1740401272",
    "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": "17411 SE 272ND ST",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980425311",
            "telephone_number": "253-631-1200",
            "fax_number": "253-631-7147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2009-07-14",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF59062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4932352",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6030498",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QFC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina Marie Foreman, LMP
• Franciscan Medical Group
• April Francisco, FNP-BC
• Adelheith E Frank, LMP
• Fred Meyer Stores Inc
• Tracy A Frigard, LMP
• Katherine Furman, LMP
• Aleina Gabriel, RBT, CBT
• Josephine Gage, MASSAGE THERAPY
• Gail a Truitt Licsw Counseling Services S Corp

• Community/Retail Pharmacy in Covington, WA
• Providers in Covington, 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 14, 2009; 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.