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Organization
VONS COMPANIES INC
Active
Organization
VONS COMPANIES INC
Active
Other names
Pavilions Pharmacy #2412
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
3901 PORTOLA PKWY, IRVINE, CA 92602-0833
(657) 273-5755
(657) 273-5760
Mailing address
250 E PARKCENTER BLVD, MS SEC2-B, BOISE, ID 83706-3940
(208) 395-6200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55613
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169386
PK
—
Enumeration date
05/10/2017
Last updated
11/02/2018
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