# SAFEWAY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Safeway Pharmacy \#4404
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053357822
- **Authorized official:** TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
- **Authorized official phone:** (208) 395-3906

## Contact information

- **Practice address:** 138 W ELLENDALE AVE, DALLAS, OR 97338-1408
- **Practice address phone:** (503) 831-6006
- **Practice address fax:** (503) 831-6008
- **Mailing address:** 250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
- **Mailing address phone:** (208) 395-3963
- **Mailing address fax:** (623) 336-6896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 0001059 | OR | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 02/19/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2078039 | PK | — |
| 05 | — | 211912 | — | OR |
| 05 | — | 269299 | — | OR |