Organization
CARR-GOTTSTEIN FOODS CO
Active
Other names
Safeway Pharmacy #1818
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2417 TONGASS AVE, KETCHIKAN, AK 99901-5900
(907) 228-1960
(907) 228-1919
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-6200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
08/06/2020
Last updated
08/06/2020
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