Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1492
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
110 E 3RD ST, PORT ANGELES, WA 98362-3010
(360) 457-0599
(360) 452-1753
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60517048
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108341
PK
—
05
—
6001226
—
WA
Enumeration date
06/21/2006
Last updated
10/29/2018
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