Organization
ALBERTSONS LLC
Active
Other names
Safeway Pharmacy #3414
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
450 N WILBUR AVE, WALLA WALLA, WA 99362-2254
(509) 529-2008
(509) 529-3788
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
PHAR.CF.60660208
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2062345
—
WA
01
—
2159937
PK
—
Enumeration date
04/29/2016
Last updated
11/15/2024
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