Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1717
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
1960 W MAIN ST, MESA, AZ 85201-6914
(480) 644-8873
(480) 644-9598
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y006169
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1990946
PK
—
05
—
546129
—
AZ
Enumeration date
07/02/2006
Last updated
10/17/2018
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