Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0932
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
950 LAS GALLINAS, SAN RAFAEL, CA 94903
(415) 472-8221
(415) 472-8225
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52093
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164451183
—
CA
01
—
1995918
PK
—
Enumeration date
07/02/2006
Last updated
04/22/2020
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