Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1656
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1601 COALTON RD, SUPERIOR, CO 80027-4610
(303) 543-2314
(303) 543-2384
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1590000002
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003325
PK
—
05
—
96579374
—
CO
Enumeration date
07/06/2006
Last updated
04/03/2020
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