Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0065
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
3355 E PERSHING BLVD, CHEYENNE, WY 82001-5764
(307) 635-1155
(307) 632-5657
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(847) 916-4463
(847) 916-4736
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10123
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125401400
—
WY
01
—
2111698
PK
—
Enumeration date
12/20/2007
Last updated
09/11/2018
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