Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #3295
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1001 N 4TH ST, COEUR D ALENE, ID 83814-3113
(208) 667-3860
(208) 664-1659
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
40542
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003486600
—
ID
05
—
1578592531
—
ID
01
—
2020942
PK
—
Enumeration date
07/02/2006
Last updated
04/02/2020
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