Organization
NAI SATURN EASTERN LLC
Active
Other names
Safeway Pharmacy #1804
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
4101 NORTHVIEW DR, BOWIE, MD 20716-2616
(301) 262-7733
(301) 262-7736
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
P06621
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149984
PK
—
05
—
641202500
—
MD
Enumeration date
07/06/2006
Last updated
09/12/2019
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