Organization
ALBERTSONS LLC
Active
Other names
SAVON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
113 N ROSS LN, MEDFORD, OR 97501-2217
(541) 858-5078
(541) 858-5042
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
RP-0001745
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079032
PK
—
05
—
208406
—
OR
Enumeration date
05/26/2006
Last updated
04/06/2020
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