Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1968
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3051 COUNTRYSIDE DR, TURLOCK, CA 95380-8400
(209) 669-2780
(209) 669-2788
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52279
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396774329
—
CA
01
—
1998082
PK
—
Enumeration date
07/02/2006
Last updated
04/14/2020
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