Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1487
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
926 E BROADWAY RD, TEMPE, AZ 85282-1502
(480) 281-1016
(480) 281-1003
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y006223
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141018
PK
—
05
—
856476
—
AZ
Enumeration date
06/05/2013
Last updated
04/13/2020
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