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Organization
ALBERTSONS LLC
Active
Organization
ALBERTSONS LLC
Active
Other names
SAVON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAN JOHNSON (MANAGER MANAGED HEALTHCARE)
(208) 395-3436
Entity
Organization
Contact information
Practice address
1818 NE EVANGELINE TRWY, LAFAYETTE, LA 70501-1922
(337) 237-9880
(337) 237-4630
Mailing address
3030 CULLERTON ST, FRANKLIN PARK, IL 60131-2205
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
3191
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1262854
—
LA
01
—
1926293
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/02/2006
Last updated
12/03/2010
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