Organization
ALBERTSONS LLC
Active
Other names
Safeway Pharmacy #0414
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
4301 212TH ST SW, MOUNTLAKE TERRACE, WA 98043
(425) 775-5011
(425) 775-3949
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
PHAR.CF.60342811
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110447
PK
—
05
—
6020770
—
WA
Enumeration date
05/26/2006
Last updated
04/03/2020
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