Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #3136
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
8145 SW BARBUR BLVD, PORTLAND, OR 97219-2849
(503) 452-6212
(503) 452-6816
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
RP-0001068-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064832
—
OR
01
—
2078048
PK
—
05
—
269244
—
OR
Enumeration date
07/02/2006
Last updated
03/31/2020
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