Organization
NAI SATURN EASTERN LLC
Active
Other names
Safeway Pharmacy #1281
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
10000 BALTIMORE NATIONAL PIKE, ELLICOTT CITY, MD 21042-3612
(410) 750-3002
(410) 750-3008
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06595
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149974
PK
—
05
—
423437500
—
MD
Enumeration date
06/21/2006
Last updated
11/29/2018
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