# SAFEWAY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sav-On Pharmacy \#3211
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295191393
- **Authorized official:** KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
- **Authorized official phone:** (208) 395-3954

## Contact information

- **Practice address:** 1120 CAMPBELL ST, BAKER CITY, OR 97814-2220
- **Practice address phone:** (541) 523-2850
- **Practice address fax:** (541) 523-6345
- **Mailing address:** 250 E PARKCENTER BLVD, BOISE, ID 83706-3940
- **Mailing address phone:** (208) 395-3906
- **Mailing address fax:** (623) 336-6896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0001967 | OR | Yes |

## Other

- **Enumeration date:** 01/06/2016
- **Last updated:** 04/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2160568 | PK | — |
| 05 | — | 500717333 | — | OR |
| 05 | — | DME 500720324 | — | OR |