Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1572
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
14020 MAIN ST NE, DUVALL, WA 98019-8457
(425) 844-1199
(425) 844-1850
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
PHAR.CF.60517526
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110742
PK
—
05
—
6024038
—
WA
Enumeration date
06/21/2006
Last updated
04/13/2020
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