Organization
SHAWS SUPERMARKETS INC
Active
Other names
SHAWS PHARMACY #2541
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLL MGR)
(208) 395-3954
Entity
Organization
Contact information
Practice address
91 AUBURN ST, NORTHGATE CENTER, PORTLAND, ME 04103
(207) 797-0536
(207) 797-2439
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-6200
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH50001473
ME
Other
Enumeration date
05/26/2006
Last updated
10/01/2024
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