Organization
RANDALLS FOOD & DRUGS LP
Active
Parent organization
SAFEWAY INC
Other names
TOM THUMB PHARMACY #1789
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAFEWAY INC
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
101 TROPHY LAKE DR, TROPHY CLUB, TX 76262-5233
(817) 490-6968
(817) 490-6985
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
22082
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4515803
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
464709
—
TX
Enumeration date
07/02/2006
Last updated
11/01/2018
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