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Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1554
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
730 MOUNTAIN VIEW RD, RAPID CITY, SD 57702-2519
(605) 342-8505
(605) 342-8903
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
100-0965
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2094022
PK
—
05
—
8502310
—
SD
05
—
9165280
—
SD
Enumeration date
07/02/2006
Last updated
04/01/2020
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