Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1458
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1500 E MAIN ST, COTTAGE GROVE, OR 97424-2208
(541) 942-7443
(541) 942-7139
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
0001336
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125679
—
OR
01
—
2078367
PK
—
05
—
269265
—
OR
Enumeration date
07/02/2006
Last updated
04/16/2020
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