Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0581
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2120 MOUNT RUSHMORE RD, RAPID CITY, SD 57701-4623
(605) 348-7552
(605) 355-4559
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
100-1005
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2094038
PK
—
05
—
8502590
—
SD
05
—
9162690
—
SD
Enumeration date
07/02/2006
Last updated
04/08/2020
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