Organization
ALBERTSONS LLC
Active
Other names
Safeway Pharmacy #1413
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3322 132ND ST SE, MILL CREEK, WA 98012-5654
(425) 338-1891
(425) 338-2863
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.60342805
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110402
PK
—
05
—
6019723
—
WA
Enumeration date
05/26/2006
Last updated
09/13/2023
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