Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0039
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
519 S HAYNES AVE, MILES CITY, MT 59301-4768
(406) 232-4627
(406) 232-0556
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
PHA-PHR-LIC-14924
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0210630
—
MT
05
—
0214863
—
MT
01
—
2051967
PK
—
Enumeration date
05/25/2006
Last updated
04/01/2020
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