Organization
SAFEWAY INC
Active
Other names
DOMINICKS
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK HARRIS CPHT MBA (MANAGED CARE ANALYST)
(623) 869-3778
Entity
Organization
Contact information
Practice address
13180 CICERO AVE, CRESTWOOD, IL 60445-1470
(708) 385-4810
(708) 385-4653
Mailing address
20427 N 27TH AVE MSC 4501, PHOENIX, AZ 85027-3241
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
54013028
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1460067
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/02/2006
Last updated
09/11/2025
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