Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #4262
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3 E 1ST ST, COQUILLE, OR 97423-1846
(541) 396-2422
(541) 396-6613
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000148
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079193
PK
—
05
—
228952
—
OR
05
—
228953
—
OR
Enumeration date
06/21/2006
Last updated
04/08/2020
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