Organization
ALBERTSONS LLC
Active
Other names
OSCO DRUG #1002
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
9243 E BASELINE RD, MESA, AZ 85209-8308
(480) 986-4660
(480) 986-4697
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y04593
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099633
—
AZ
01
—
1991061
PK
—
Enumeration date
06/07/2006
Last updated
04/03/2020
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