# SAFEWAY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083160147
- **Authorized official:** SEAN CLARK (RPH)
- **Authorized official phone:** (541) 660-7657

## Contact information

- **Practice address:** 2001 TABLE ROCK RD, APT 28, MEDFORD, OR 97501-1483
- **Practice address phone:** (541) 660-7657
- **Mailing address:** 2001 TABLE ROCK RD, APT 28, MEDFORD, OR 97501-1483
- **Mailing address phone:** (541) 660-7657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 0015445 | OR | Yes |

## Other

- **Enumeration date:** 08/29/2016
- **Last updated:** 08/29/2016