NPIMap

Organization Active NPI

Fred Meyer Stores Inc

Doing business as Fred Meyer Pharmacy

  • Community/Retail Pharmacy
  • Boise, ID
National Provider Identifier
1902842594
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1574RP Issued in ID
Legal business name
FRED MEYER STORES INC
Doing business as
Fred Meyer Pharmacy
Practice address
3527 S Federal Way
Boise, ID 83705-5204
Phone
(208) 424-7533
Fax
(208) 424-7527
NPI assigned
Jun 21, 2006
Last updated
Aug 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2016

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 1574RP ID Primary

Addresses

Primary practice location

3527 S Federal Way
Boise, ID 83705-5204

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
805965100MedicaidID
2021752OtherPK

Other names 1

  • FRED MEYER PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091006000210 ID Part B Supplier - Mass Immunization (Roster Biller Only) 1254234586 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Meridian, ID; Twin Falls, ID; Pocatello, ID; Nampa, ID; Garden City, ID; Boise, ID; Coeur D Alene, ID; Idaho Falls, ID
O20100930001590 ID DME Supplier - Pharmacy 1254234586 Practice locations: Boise, ID

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
13D0985335Fred Meyer Pharmacy #6133527 S Federal Way, Boise, ID 83705Certificate of waiverApr 15, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Fred Meyer Pharmacy #6133527 S Federal Way, Boise, ID 83705-5204(208) 424-7533 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

National Provider Directory

National Provider Directory
Tax ID family
Fred Meyer Store Inc174 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

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

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470960000000",
    "number": "1902842594",
    "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": "3527 S FEDERAL WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837055204",
            "telephone_number": "208-424-7533",
            "fax_number": "208-424-7527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED MEYER STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2016-08-12",
        "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": "ID",
            "license": "1574RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805965100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2021752",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FRED MEYER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.