Organization
ALBERTSONS LLC
Active
Other names
ALBERTSONS PHARMACY #1708
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
729 N REDWOOD RD, SALT LAKE CITY, UT 84116-1909
(801) 532-3795
(801) 532-4909
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
9404145-1703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235516600
—
UT
01
—
2151908
PK
—
Enumeration date
05/05/2015
Last updated
04/03/2020
Update your record
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