Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2718
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
110 STRAWBERRY VILLAGE BLVD, BLDG 100, MILL VALLEY, CA 94941
(415) 360-9020
(415) 360-9021
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83712-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52317
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790711570
—
CA
01
—
1994154
PK
—
Enumeration date
06/24/2006
Last updated
10/04/2018
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