# ALBERTSONS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Safeway Pharmacy \#0536
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669428215
- **Authorized official:** KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
- **Authorized official phone:** (208) 395-3954

## Contact information

- **Practice address:** 25691 SE STARK ST, TROUTDALE, OR 97060-3305
- **Practice address phone:** (503) 667-9003
- **Practice address fax:** (503) 667-9513
- **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 | RP-0001883 | OR | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 01/20/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2079128 | PK | — |
| 05 | — | 230453 | — | OR |