Organization
ALBERTSONS LLC
Active
Other names
OSCO DRUG #0004
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3130 W CAREFREE HWY, PHOENIX, AZ 85086-3200
(623) 582-2743
(623) 582-8074
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y04594
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099624
—
AZ
01
—
1991596
PK
—
Enumeration date
06/04/2006
Last updated
04/01/2020
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