Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0792
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
17023 SE 272ND ST, COVINGTON, WA 98042-4948
(253) 631-2450
(253) 631-2451
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
PHAR.CF.60516324
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108370
PK
—
05
—
6003156
—
WA
Enumeration date
06/21/2006
Last updated
04/03/2020
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