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Organization

SAFEWAY INC

Active
Other names
SAFEWAY PHARMACY #0521
Organization subpart
No

Provider details

NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization

Contact information

Practice address
20151 SE HIGHWAY 212, BORING, OR 97089-9220
(503) 658-7005
(503) 658-7081
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
0001006
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
111930
OR
01
2077957
PK
05
269248
OR
Enumeration date
07/02/2006
Last updated
04/03/2020
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