Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1568
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
40 COUNTY ROAD 804, FRASER, CO 80442
(970) 726-6920
(970) 726-6836
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
PDO.1620000001
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003357
PK
—
05
—
45702845
—
CO
Enumeration date
07/02/2006
Last updated
04/03/2020
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