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Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2897
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
91-1119 KEAUNUI DR, EWA BEACH, HI 96706-6355
(808) 683-3205
(800) 683-3209
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHY-862
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137429
PK
—
05
—
734097
—
HI
Enumeration date
10/15/2012
Last updated
10/05/2018
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