Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0383
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1320 S BLAINE ST, MOSCOW, ID 83843-3971
(208) 882-2663
(208) 882-0297
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
40534RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073559696
—
ID
01
—
2021434
PK
—
05
—
805376700
—
ID
Enumeration date
06/21/2006
Last updated
03/12/2020
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