Organization
ALBERTSONS LLC
Active
Other names
Albertsons Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
6249 RUFE SNOW DR, WATAUGA, TX 76148-3316
(817) 428-0371
(817) 428-2616
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
27090
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126529
PK
—
05
—
466714
—
TX
Enumeration date
09/22/2010
Last updated
04/08/2020
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