Organization
ALBERTSONS LLC
Active
Other names
Sav-On Pharmacy 3106
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
11012 CANYON RD E, PUYALLUP, WA 98373-4200
(253) 537-1517
(253) 539-3654
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
Primary
PHAR.CF.60629623
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2061558
—
WA
01
—
2158031
PK
—
Enumeration date
02/04/2016
Last updated
04/03/2020
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