Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0062
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2625 E 2ND ST, CASPER, WY 82609-2045
(307) 234-7159
(307) 237-0971
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
R10150
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125397200
—
WY
01
—
2111701
PK
—
Enumeration date
12/20/2007
Last updated
04/01/2020
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