Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2870
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
6310 COLLEGE AVE, OAKLAND, CA 94618-1332
(510) 985-0017
(510) 985-1582
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY53417
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396039624
—
CA
01
—
2130571
PK
—
Enumeration date
06/03/2011
Last updated
05/20/2020
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