Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1297
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
23632 HIGHWAY 99, EDMONDS, WA 98026-9211
(425) 775-1030
(425) 774-1780
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
PHAR.CF.60516811
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108898
PK
—
05
—
6009823
—
WA
Enumeration date
06/21/2006
Last updated
04/02/2020
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