Organization
SAFEWAY INC
Active
Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1537
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
212 ELKS POINT RD, ZEPHYR COVE, NV 89448-8001
(775) 586-1088
(775) 586-9019
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH01196
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639181506
—
NV
01
—
2050939
PK
—
Enumeration date
08/12/2006
Last updated
09/12/2019
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