# SAFEWAY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SAFEWAY PHARMACY \#1504
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790716504
- **Authorized official:** KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
- **Authorized official phone:** (208) 395-3954

## Contact information

- **Practice address:** 2650 NE HIGHWAY 20, BEND, OR 97701-6976
- **Practice address phone:** (541) 383-6509
- **Practice address fax:** (541) 383-6513
- **Mailing address:** 250 E PARKCENTER BLVD, BOISE, ID 83706-3940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 0001462 | OR | Yes |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 04/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 133632 | — | OR |
| 01 | — | 2078473 | PK | — |
| 05 | — | 269278 | — | OR |