Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1470
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
121 W NEIDER AVE, COEUR D ALENE, ID 83815-9300
(208) 765-4410
(208) 765-0451
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
40536RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0034868
—
ID
05
—
1164468781
—
ID
01
—
2021426
PK
—
Enumeration date
06/21/2006
Last updated
04/06/2020
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