Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1472
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
315 E COLLEGE WAY, MOUNT VERNON, WA 98273-5431
(360) 424-0467
(360) 424-0427
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.60517005
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108970
PK
—
05
—
6010433
—
WA
Enumeration date
06/21/2006
Last updated
04/02/2020
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