Organization
NAI SATURN EASTERN LLC
Active
Other names
Safeway Pharmacy #2635
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
12821 BRAEMAR VILLAGE PLZ, BRISTOW, VA 20136-5502
(703) 257-0436
(703) 257-4642
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(847) 916-4463
(847) 916-4736
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201003956
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010042488
—
VA
01
—
2150047
PK
—
Enumeration date
06/21/2006
Last updated
09/27/2018
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