Organization
JEWEL OSCO SOUTHWEST LLC
Active
Parent organization
ALBERTSONS HOLDINGS LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ALBERTSONS HOLDINGS LLC
Authorized official
MR. LORENZO TORRES III (PHARMACY ENROLLMENT SPECIALIST)
(208) 395-3963
Entity
Organization
Contact information
Practice address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6363
Mailing address
75 REMITTANCE DRIVE, SUITE 1242, CHICAGO, IL 60675-1242
(847) 916-4463
(847) 916-4736
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00447103
RAILROAD MEDICARE TPAN
—
Enumeration date
09/27/2006
Last updated
07/21/2022
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