Organization
SAFEWAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
664 W EVERGREEN AVE, PALMER, AK 99645-6535
(907) 761-1460
(907) 761-1419
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-6200
(623) 282-3834
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
110065
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021517
—
AK
05
—
1028505
—
AK
01
—
1996612
PK
—
Enumeration date
07/19/2006
Last updated
04/03/2020
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