Provider Demographics
NPI:1104676568
Name:FRED MEYER STORES INC.
Entity type:Organization
Organization Name:FRED MEYER STORES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING ASP
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-246-3091
Mailing Address - Street 1:1014 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1141
Mailing Address - Country:US
Mailing Address - Phone:513-246-3091
Mailing Address - Fax:513-762-1092
Practice Address - Street 1:22131 SE 237TH ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8533
Practice Address - Country:US
Practice Address - Phone:425-433-2078
Practice Address - Fax:425-358-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies