Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0067
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2610 S DOUGLAS HWY, GILLETTE, WY 82718-6468
(307) 687-2996
(307) 686-6153
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10149
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125403100
—
WY
01
—
2111694
PK
—
Enumeration date
12/20/2007
Last updated
04/02/2020
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