Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0635
Organization subpart
No
Provider details
NPI number
Authorized official
MANAGED CARE CPHT (MANAGED CARE PLAN SPECIALIST)
(925) 467-2806
Entity
Organization
Contact information
Practice address
1295 W VICTORY WAY, CRAIG, CO 81625-2943
(970) 824-8118
(970) 824-9517
Mailing address
5918 STONERIDGE MALL RD, PLEASANTON, CA 94588-3229
(925) 467-2802
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0276
CO
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03001369
—
CO
01
—
0613263
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
P00229889
RAILROAD
—
01
—
PHC015
FLU
—
Enumeration date
07/02/2006
Last updated
06/05/2013
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