Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1139
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE ANN RIVERS CPHT (MANAGED CARE PLAN SPECIALIST)
(623) 869-3524
Entity
Organization
Contact information
Practice address
90 FIFTH ST, DOUGLAS, AZ 85607
(520) 364-7568
(520) 364-9053
Mailing address
20427 N 27TH AVE # MSC4551, PHOENIX, AZ 85027-3241
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
P02518
AZ
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016820210004
—
AZ
01
—
0320135
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
147050
—
AZ
Enumeration date
07/02/2006
Last updated
12/01/2008
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