Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1556
Organization subpart
No
Provider details
NPI number
Authorized official
DEMOND HAWKINS (MGR, HOST ADMIN & ENROLLMENTS)
(208) 395-3905
Entity
Organization
Contact information
Practice address
230 JOHNSON STREET, COOS BAY, OR 97420
(541) 267-1709
(541) 267-1712
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000165
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136437
—
OR
01
—
2078499
PK
—
05
—
269287
—
OR
Enumeration date
07/02/2006
Last updated
12/21/2016
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