Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1471
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
26916 MAPLE VALLEY BLACK DIAMOND RD SE, MAPLE VALLEY, WA 98038-8322
(425) 432-3077
(425) 432-2949
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60516922
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108492
PK
—
05
—
6005177
—
WA
Enumeration date
06/24/2006
Last updated
04/02/2020
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