Organization
UNITED SUPERMARKETS LLC
Active
Other names
ALBERTSONS MARKET PHARMACY #0905
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2910 JUAN TABO BLVD NE, ALBUQUERQUE, NM 87112-1828
(505) 299-8600
(505) 299-8609
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
PH00004425
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2059018
PK
—
05
—
86835262
—
NM
Enumeration date
07/06/2007
Last updated
05/11/2026
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