Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0415
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
4101 NW LOGAN RD, LINCOLN CITY, OR 97367-5056
(541) 994-2500
(541) 994-8438
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, 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
0000769
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067561
—
OR
01
—
2077805
PK
—
05
—
269246
—
OR
Enumeration date
07/02/2006
Last updated
03/12/2020
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