Organization
ALBERTSONS LLC
Active
Other names
Albertsons Pharmacy #4277
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3525 SYCAMORE SCHOOL RD, FT WORTH, TX 76133-7805
(817) 346-4457
(817) 294-4792
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
12540
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2097184
PK
—
05
—
462920
—
TX
Enumeration date
06/02/2006
Last updated
06/17/2025
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