Organization
ALBERTSONS LLC
Active
Other names
Safeway Pharmacy #0254
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
161 W PRAIRIE AVE, HAYDEN, ID 83835
(208) 772-7864
(208) 772-7905
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
21048RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021444
PK
—
05
—
804296700
—
ID
05
—
807493900
—
ID
Enumeration date
05/26/2006
Last updated
04/04/2024
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