Organization
ALBERTSONS LLC
Active
Other names
ALBERTSONS PHARMACY #0611
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3710 N STATE LINE AVE, TEXARKANA, AR 71854-1934
(870) 773-5521
(870) 774-8426
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR17558
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121367407
—
AR
01
—
1995178
PK
—
Enumeration date
06/04/2006
Last updated
08/21/2024
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