Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2811
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE ANN RIVERS CPHT (MANAGED CARE PLAN SPECIALIST)
(623) 869-3524
Entity
Organization
Contact information
Practice address
3335 N ACADEMY BLVD, COLORADO SPRINGS, CO 80917-5103
(719) 574-1560
(719) 574-3540
Mailing address
20427 N 27TH AVE # MSC4551, PHOENIX, AZ 85027-3241
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
02459
CO
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03765328
—
CO
01
—
0606369
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
P00229889
RR #
CO
01
—
PHC015
FLU #
CO
Enumeration date
06/21/2006
Last updated
12/15/2008
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