Organization
ALBERTSONS LLC
Active
Other names
SAV-ON PHARMACY #1165, Sav-On Pharmacy #1165
Organization subpart
No
Provider details
NPI number
Authorized official
DEMOND HAWKINS (THIRD PARTY MANAGER)
(208) 395-3905
Entity
Organization
Contact information
Practice address
2291 W MALVERN AVE, FULLERTON, CA 92833-2106
(714) 992-6739
(714) 992-6827
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-6200
(208) 495-4503
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51323
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071PHA455500
—
CA
05
—
071PHA476860
—
CA
01
—
1998633
PK
—
Enumeration date
05/26/2006
Last updated
07/19/2018
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