Organization
ALBERTSONS LLC
Active
Other names
Sav-On Pharmacy #0165
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
528 N MAIN ST, MOUNTAIN HOME, ID 83647
(208) 587-3365
(208) 587-1545
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
21072RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002255500
—
ID
01
—
2020662
PK
—
05
—
807494600
—
ID
Enumeration date
05/26/2006
Last updated
04/02/2020
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