Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2624
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3600 W 144TH AVE, BROOMFIELD, CO 80023-9502
(303) 209-2416
(303) 209-2409
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
PDO.0120000014
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10102876
—
CO
01
—
2003484
PK
—
Enumeration date
07/06/2006
Last updated
04/13/2020
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