Organization
ALBERTSONS LLC
Active
Other names
SAFEWAY PHARMACY #2248
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1304 N LIBERTY LAKE RD, LIBERTY LAKE, WA 99019-8523
(509) 891-6967
(509) 891-0584
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
PHAR.CF.60343064
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109584
PK
—
05
—
6013577
—
WA
Enumeration date
05/26/2006
Last updated
04/03/2020
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