Organization
ALBERTSONS LLC
Active
Other names
OSCO DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
LORENZO TORRES (NEW STORE ENROLLMENTS)
(847) 916-4463
Entity
Organization
Contact information
Practice address
4820 E RAY RD, PHOENIX, AZ 85044-6402
(480) 893-1974
(480) 592-9276
Mailing address
4820 E RAY RD, PHOENIX, AZ 85044-6402
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y04553
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0318673
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
100621
—
AZ
Enumeration date
06/04/2006
Last updated
11/21/2007
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