Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2054
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
13503 W CAMINO DEL SOL, SUN CITY WEST, AZ 85375-4439
(623) 584-0501
(623) 546-5538
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83712-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y006154
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135360
—
AZ
01
—
1989563
PK
—
Enumeration date
07/02/2006
Last updated
04/02/2020
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