Organization
SHAWS SUPERMARKETS INC
Active
Other names
Shaws Pharmacy #4572
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3932
Entity
Organization
Contact information
Practice address
370 WESTERN AVE, BRIGHTON, MA 02135
(617) 782-1628
(617) 782-1269
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-6200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
DS3218
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110000003O
—
MA
01
—
2038250
PK
—
Enumeration date
05/26/2006
Last updated
07/08/2024
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