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Organization

SAFEWAY INC

Active
Other names
SAFEWAY PHARMACY #1665
Organization subpart
No

Provider details

NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization

Contact information

Practice address
1705 S HIGHWAY 97, REDMOND, OR 97756-9647
(541) 504-4166
(541) 504-4168
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
0000476
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2077811
PK
05
223404
OR
05
297019
OR
Enumeration date
07/02/2006
Last updated
04/27/2020
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  • Eligibility checks
  • EDI platform