Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1601
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2490 NE HIGHWAY 99W, MCMINNVILLE, OR 97128-9204
(503) 435-3125
(503) 435-3128
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0001627
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170189
—
OR
01
—
2078827
PK
—
05
—
269220
—
OR
Enumeration date
07/02/2006
Last updated
04/06/2020
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