Organization
SHAWS SUPERMARKETS INC
Active
Other names
Shaws Pharmacy #3483
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3932
Entity
Organization
Contact information
Practice address
55 CRYSTAL AVE, DERRY, NH 03038
(603) 437-9654
(603) 437-7076
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
0585P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2053525
PK
—
05
—
3074455
—
NH
Enumeration date
05/25/2006
Last updated
07/09/2024
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