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Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
Sav-On Pharmacy #3211
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1120 CAMPBELL ST, BAKER CITY, OR 97814-2220
(541) 523-2850
(541) 523-6345
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3906
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RP-0001967
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160568
PK
—
05
—
500717333
—
OR
05
—
DME 500720324
—
OR
Enumeration date
01/06/2016
Last updated
04/21/2020
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