Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY # 1955
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE RIVERS CPHT (MANAGED CARE PLAN SPECIALIST)
(623) 869-3524
Entity
Organization
Contact information
Practice address
20713 N 83RD AVE, PEORIA, AZ 85382-7427
(623) 476-1650
(623) 476-1644
Mailing address
20427 N 27TH AVE # MSC4551, PHOENIX, AZ 85027-3241
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Y03469
AZ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0327141
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
760919
—
AZ
Enumeration date
07/02/2006
Last updated
01/19/2009
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