Provider Demographics
NPI:1891030300
Name:FRED MEYER PHARMACY
Entity Type:Organization
Organization Name:FRED MEYER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMRO
Authorized Official - Middle Name:ABU
Authorized Official - Last Name:HALLAWAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:253-752-9110
Mailing Address - Street 1:4505 SOUTH 19TH
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-752-9110
Mailing Address - Fax:253-756-9320
Practice Address - Street 1:4505 SOUTH 19TH
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-752-9110
Practice Address - Fax:253-756-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009951261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health