Organization
ALBERTSONS LLC
Active
Other names
SAVON PHARMACY #2303
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
7201 BOULDER AVE, HIGHLAND, CA 92346-3313
(909) 425-1194
(909) 425-8647
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
PHY51343
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071PHA389120
—
CA
05
—
071PHA476360
—
CA
01
—
2062420
PK
—
Enumeration date
05/25/2006
Last updated
04/03/2020
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