Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #0010
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3851 S HIGHWAY 74, EVERGREEN, CO 80439
(303) 209-5274
(303) 209-5275
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.0000000618
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003828
PK
—
05
—
97025330
—
CO
Enumeration date
06/24/2006
Last updated
03/09/2020
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