Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1997
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
17049 W BELL RD, SURPRISE, AZ 85374-2976
(623) 518-1063
(623) 518-1064
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
Y006149
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112501
—
AZ
01
—
1991960
PK
—
Enumeration date
06/21/2006
Last updated
10/17/2018
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