Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0983
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1071 11TH ST, LAKEPORT, CA 95453-4105
(707) 263-8779
(707) 263-8783
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52175
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376793521
—
CA
01
—
2117428
PK
—
Enumeration date
09/24/2008
Last updated
04/14/2020
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