Organization
SAFEWAY INC
Active
Other names
Safeway Pharmacy #3317
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
3355 BETHEL RD SE, PORT ORCHARD, WA 98366-5635
(360) 329-5465
(360) 329-5469
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60629339
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2064139
—
WA
01
—
2158269
PK
—
Enumeration date
12/22/2015
Last updated
04/13/2020
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