Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1611
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
6711 NE 63RD ST, VANCOUVER, WA 98661-1997
(360) 992-5686
(360) 992-5688
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
PHAR.CF.60517570
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110503
PK
—
05
—
6021364
—
WA
Enumeration date
07/06/2006
Last updated
04/03/2020
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