Organization
CARR-GOTTSTEIN FOODS CO
Active
Organization
CARR-GOTTSTEIN FOODS CO
Active
Other names
SAFEWAY PHARMACY #1821
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
301 N SANTA CLAUS LN, NORTH POLE, AK 99705-6081
(907) 490-2760
(907) 490-2719
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
377
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1028565
—
AK
05
—
1603171
—
AK
01
—
1996884
PK
—
Enumeration date
07/02/2006
Last updated
03/04/2020
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