Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1517
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
890 W WILLIAMS AVE, FALLON, NV 89406-2652
(775) 428-2340
(775) 428-2341
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
PH02803
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811261704
—
NV
01
—
2133939
PK
—
Enumeration date
02/24/2012
Last updated
04/21/2020
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