Provider Demographics
NPI:1063897239
Name:FRED MEYER
Entity type:Organization
Organization Name:FRED MEYER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST GRADUATE INTERN
Authorized Official - Prefix:
Authorized Official - First Name:LE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TRANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:503-286-6784
Mailing Address - Street 1:7404 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5528
Mailing Address - Country:US
Mailing Address - Phone:503-286-6784
Mailing Address - Fax:503-286-6792
Practice Address - Street 1:7404 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5528
Practice Address - Country:US
Practice Address - Phone:503-286-6784
Practice Address - Fax:503-286-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy