Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #1010
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3800 S RUSSELL ST, MISSOULA, MT 59801-8525
(406) 549-7717
(406) 549-7659
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
PHA-PHR-LIC-14981
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0211242
—
MT
05
—
0214676
—
MT
01
—
2052012
PK
—
Enumeration date
06/02/2006
Last updated
04/03/2020
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