Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2723
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1815 4TH ST, TILLAMOOK, OR 97141-2210
(503) 842-5934
(503) 842-6842
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
0000905
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2077884
PK
—
05
—
213332
—
OR
05
—
269307
—
OR
05
—
291450
—
OR
Enumeration date
07/30/2006
Last updated
04/06/2020
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