Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0006
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
200 S 23RD AVE, BOZEMAN, MT 59718-3965
(406) 587-8800
(406) 587-8122
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
PHA-PHR-LIC-14980
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0214643
—
MT
05
—
0220363
—
MT
01
—
2051828
PK
—
Enumeration date
05/26/2006
Last updated
04/01/2020
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