Organization
ALBERTSONS LLC
Active
Other names
ALBERTSONS PHARMACY #2798
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2750 COUNTRY CLUB RD, LAKE CHARLES, LA 70605-5914
(337) 480-4132
(337) 480-0435
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
4748
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1269344
—
LA
01
—
2035053
PK
—
Enumeration date
06/07/2006
Last updated
04/03/2020
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