Organization
ALBERTSONS LLC
Active
Other names
SAVON PHARMACY #0561
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
298 E LIVE OAK AVE, ARCADIA, CA 91006-5629
(626) 446-1902
(626) 446-0792
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51353
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071PHA477020
—
CA
01
—
1993095
PK
—
05
—
4H0PHA406490
—
CA
Enumeration date
05/25/2006
Last updated
04/03/2020
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