Organization
NAI SATURN EASTERN LLC
Active
Other names
Safeway Pharmacy #1606
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
9596 OLD KEENE MILL RD, BURKE, VA 22015-4208
(703) 440-1344
(703) 440-1348
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
0201003727
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150041
PK
—
05
—
8502897
—
VA
Enumeration date
07/06/2006
Last updated
09/27/2018
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