Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1619
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1109 E YELM AVE, YELM, WA 98597-7683
(360) 458-8835
(360) 458-8841
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.60517575
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110543
PK
—
05
—
6022255
—
WA
Enumeration date
06/21/2006
Last updated
04/02/2020
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