Organization
NAI SATURN EASTERN LLC
Active
Other names
Safeway Pharmacy #1702
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
4215 CHESHIRE STATION PLZ, DALE CITY, VA 22193-2217
(703) 590-8021
(703) 590-6702
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
(847) 916-4463
(847) 916-4736
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201003797
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150037
PK
—
05
—
8515506
—
VA
Enumeration date
07/02/2006
Last updated
11/16/2022
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