Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2106
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
6580 US HIGHWAY 93 S, WHITEFISH, MT 59937-2959
(406) 862-2526
(406) 862-6294
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHA-PHR-LIC-27862
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000220987
—
MT
05
—
0005605535
—
MT
01
—
2051878
PK
—
Enumeration date
07/02/2006
Last updated
04/06/2020
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