Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #3095
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2980 E CAPITOL EXPY, SAN JOSE, CA 95148-4246
(408) 274-5939
(408) 274-5954
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
PHY53412
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619372646
—
CA
01
—
2149488
PK
—
Enumeration date
11/04/2014
Last updated
04/08/2020
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