Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1615
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3325 28TH ST, BOULDER, CO 80301-1440
(303) 938-9284
(303) 938-9297
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
PDO.0090000044
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003464
PK
—
05
—
68551738
—
CO
Enumeration date
06/21/2006
Last updated
04/06/2020
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