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Organization
ALBERTSONS LLC
Active
Organization
ALBERTSONS LLC
Active
Other names
Safeway Pharmacy #0536
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
25691 SE STARK ST, TROUTDALE, OR 97060-3305
(503) 667-9003
(503) 667-9513
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RP-0001883
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079128
PK
—
05
—
230453
—
OR
Enumeration date
05/25/2006
Last updated
01/20/2023
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