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Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #4469
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
246 W MONROE ST, BURNS, OR 97720-2033
(541) 573-8586
(541) 573-8588
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
0000954
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109033
—
OR
01
—
2077903
PK
—
05
—
269302
—
OR
Enumeration date
07/02/2006
Last updated
09/28/2018
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