Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1643
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3169 CRATER LAKE HWY, MEDFORD, OR 97504-9179
(541) 774-4346
(541) 774-4348
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
0001673
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168084
—
OR
01
—
2078898
PK
—
05
—
269234
—
OR
Enumeration date
07/06/2006
Last updated
04/13/2020
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