Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1117
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
75-971 HENRY ST, KAILUA KONA, HI 96740
(808) 327-6778
(808) 327-6782
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY-864
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2121359
PK
—
05
—
631714
—
HI
Enumeration date
07/23/2009
Last updated
02/23/2021
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