# SAFEWAY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SAFEWAY PHARMACY \#1556
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588693527
- **Authorized official:** DEMOND HAWKINS (MGR, HOST ADMIN & ENROLLMENTS)
- **Authorized official phone:** (208) 395-3905

## Contact information

- **Practice address:** 230 JOHNSON STREET, COOS BAY, OR 97420
- **Practice address phone:** (541) 267-1709
- **Practice address fax:** (541) 267-1712
- **Mailing address:** 250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
- **Mailing address phone:** (208) 395-3963
- **Mailing address fax:** (623) 336-6896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 0000165 | OR | Yes |

## Other

- **Enumeration date:** 07/02/2006
- **Last updated:** 12/21/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 136437 | — | OR |
| 01 | — | 2078499 | PK | — |
| 05 | — | 269287 | — | OR |