Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0583
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1606 NORTH AVE STE 2, SPEARFISH, SD 57783-1250
(605) 642-3039
(605) 644-0744
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
100-0533
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2094212
PK
—
05
—
8503860
—
SD
05
—
9165650
—
SD
Enumeration date
07/02/2006
Last updated
04/01/2020
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