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Organization

ALBERTSONS LLC

Active
Other names
Safeway Pharmacy #0149
Organization subpart
No

Provider details

NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization

Contact information

Practice address
1610 W LINCOLN AVE, YAKIMA, WA 98902
(509) 452-6567
(509) 469-1778
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
PHAR.CF.60342951
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2109527
PK
05
6013452
WA
Enumeration date
05/26/2006
Last updated
04/02/2020
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