# ALBERTSONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ALBERTSONS PHARMACY \#1708
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235516600
- **Authorized official:** KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
- **Authorized official phone:** (208) 395-3954

## Contact information

- **Practice address:** 729 N REDWOOD RD, SALT LAKE CITY, UT 84116-1909
- **Practice address phone:** (801) 532-3795
- **Practice address fax:** (801) 532-4909
- **Mailing address:** 250 E PARKCENTER BLVD, BOISE, ID 83706-3940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9404145-1703 | UT | Yes |

## Other

- **Enumeration date:** 05/05/2015
- **Last updated:** 04/03/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1235516600 | — | UT |
| 01 | — | 2151908 | PK | — |