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Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1504
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2650 NE HIGHWAY 20, BEND, OR 97701-6976
(541) 383-6509
(541) 383-6513
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
0001462
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133632
—
OR
01
—
2078473
PK
—
05
—
269278
—
OR
Enumeration date
07/06/2006
Last updated
04/22/2020
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