# ALBERTSONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ALBERTSONS PHARMACY \#0717
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598702011
- **Authorized official:** KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
- **Authorized official phone:** (208) 395-3954

## Contact information

- **Practice address:** 4060 RYAN ST, LAKE CHARLES, LA 70605-2841
- **Practice address phone:** (337) 478-9197
- **Practice address fax:** (337) 480-0070
- **Mailing address:** 250 E PARKCENTER BLVD, BOISE, ID 83706-3940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 2660 | LA | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 04/03/2020