Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1055
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
7720 E HWY 69, PRESCOTT VALLEY, AZ 86314
(928) 772-7673
(928) 772-6283
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
Y006211
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1988879
PK
—
05
—
305088
—
AZ
Enumeration date
07/02/2006
Last updated
04/06/2020
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