Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #630
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2334 CENTRAL AVE, BILLINGS, MT 59102-4665
(406) 656-6652
(406) 656-6233
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
PHA-PHR-LIC-15010
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0210868
—
MT
05
—
0214786
—
MT
01
—
2051962
PK
—
Enumeration date
06/02/2006
Last updated
04/03/2020
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