Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2764
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1451 RITCHIE HWY, ARNOLD, MD 21012-2502
(410) 757-7792
(410) 757-0242
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3954
(925) 467-2802
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P01536
—
3336C0003X
Community/Retail Pharmacy
Primary
P01536
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062222200
—
MD
01
—
2116792
NCPDP
—
Enumeration date
09/19/2008
Last updated
04/15/2020
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