Organization
SHAWS SUPERMARKETS INC
Active
Other names
SHAWS PHARMACY #2552
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLL MGR)
(208) 395-3954
Entity
Organization
Contact information
Practice address
150 WESTERN AVE, AUGUSTA, ME 04330
(207) 626-0364
(207) 626-0470
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
PH50001481
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144820002
—
ME
01
—
2037451
PK
—
05
—
999020365
—
ME
Enumeration date
05/30/2006
Last updated
10/01/2024
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