Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2900
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
5760 COTTLE RD, SAN JOSE, CA 95123-3624
(408) 362-9623
(408) 362-9741
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
PHY53411
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114320306
—
CA
01
—
2148235
PK
—
Enumeration date
10/01/2014
Last updated
04/16/2020
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