Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2004
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3540 E MAIN ST, FARMINGTON, NM 87402-5329
(505) 564-3086
(505) 564-3089
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003868
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000N1393
—
NM
01
—
2058856
PK
—
Enumeration date
06/21/2006
Last updated
04/01/2020
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