Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0019
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
117 W JANEAUX ST, LEWISTOWN, MT 59457-3073
(406) 538-6674
(406) 538-6675
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
PHA-PHR-LIC-14919
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0210698
—
MT
05
—
0214710
—
MT
01
—
2051955
PK
—
Enumeration date
05/25/2006
Last updated
04/01/2020
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