Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #3013
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (MANAGER ENROLLMENTS)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3680 CROCKER DR, STE 100, SACRAMENTO, CA 95818
(279) 399-9270
(279) 399-9262
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CA
Enumeration date
10/19/2018
Last updated
12/13/2019
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