Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1266
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
11290 DONNER PASS RD, TRUCKEE, CA 96161-4808
(530) 582-7952
(530) 582-7965
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83712-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52234
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770529307
—
CA
01
—
1995699
PK
—
Enumeration date
06/21/2006
Last updated
10/26/2018
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