Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1512
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE ANN RIVERS CPHT (MANAGED CARE PLAN SPECIALIST)
(623) 869-3524
Entity
Organization
Contact information
Practice address
4823 KIETZKE LN, RENO, NV 89509-6549
(775) 823-2323
(775) 823-2326
Mailing address
20427 N 27TH AVE # MS 4551, PHOENIX, AZ 85027-3241
(623) 869-3524
(623) 869-1232
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PH1065
NV
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2816016
—
NV
01
—
2905822
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/24/2006
Last updated
03/04/2009
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