Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0064
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
1865 COFFEEN AVE, SHERIDAN, WY 82801-5711
(307) 672-8908
(307) 672-5445
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-3906
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10148
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125400600
—
WY
01
—
2111699
PK
—
Enumeration date
12/20/2007
Last updated
09/11/2018
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