NPIMap

Organization Active NPI

Fred Meyer Stores Inc

  • Community/Retail Pharmacy
  • Monroe, WA
National Provider Identifier
1760428205
Registry record updated Jun 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
CF00005152 Issued in WA
Legal business name
FRED MEYER STORES INC
Practice address
18805 State Route 2
Monroe, WA 98272-1438
Phone
(360) 805-8133
Fax
(360) 805-8127
NPI assigned
Jun 22, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Allison Muennich
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1019

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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
50D0965106Fred Meyer Pharmacy #21018805 State Route 2, Monroe, WA 98272Certificate of waiverApr 4, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Fred Meyer Pharmacy18805 State Route 2, Monroe, WA 98272-1438(360) 805-8133 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 assignmentParticipating since Jul 1, 1966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040220000567 WA Part B Supplier - Mass Immunization (Roster Biller Only) 1254234586 This NPI is an additional NPI on the enrollment
O20100930014113 WA DME Supplier - PharmacyDME Supplier - Grocery Store 1254234586 Practice locations: Monroe, WA

National Provider Directory

National Provider Directory
Tax ID family
Fred Meyer Pharmacy (174 organizations share this tax ID)

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X CF00005152 WA Primary

Addresses

NPPES NPI Registry

Primary practice location

18805 State Route 2
Monroe, WA 98272-1438

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
2110132OtherPK
6015150MedicaidWA

Other names 1

NPPES NPI Registry
  • FRED MEYER PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 28, 2016.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1760428205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18805 STATE ROUTE 2",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721438",
            "telephone_number": "360-805-8133",
            "fax_number": "360-805-8127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "MUENNICH",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00005152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2110132",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6015150",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FRED MEYER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.