Organization
SAFEWAY INC
Active
Other names
Safeway Pharmacy #4711
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE RIVERS (MANAGED CARE PLAN SPECIALIST)
(623) 869-3524
Entity
Organization
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 266-7542
(541) 266-7638
Mailing address
20427 N 27TH AVE # MS 4551, PHOENIX, AZ 85027-3241
(623) 869-3524
(623) 869-1232
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053557801
—
OR
01
—
3843441
NCPDP
OR
Enumeration date
12/29/2008
Last updated
05/20/2010
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