Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0964
Organization subpart
No
Provider details
NPI number
Authorized official
DEMOND HAWKINS (THIRD PARTY MANAGER)
(208) 395-3905
Entity
Organization
Contact information
Practice address
4950 MISSION ST, SAN FRANCISCO, CA 94112-3416
(415) 239-8010
(415) 239-8066
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83712-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52108
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215966247
—
CA
01
—
1996484
PK
—
Enumeration date
07/02/2006
Last updated
07/19/2018
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