Organization
SAFEWAY INC
Active
Other names
Safeway Pharmacy #4404
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
138 W ELLENDALE AVE, DALLAS, OR 97338-1408
(503) 831-6006
(503) 831-6008
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0001059
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2078039
PK
—
05
—
211912
—
OR
05
—
269299
—
OR
Enumeration date
06/21/2006
Last updated
02/19/2024
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