Organization
ALBERTSONS LLC
Active
Other names
ALBERTSONS PHARMACY #0197
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
11475 E VIA LINDA, SCOTTSDALE, AZ 85259
(480) 767-7274
(480) 767-7329
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y006816
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127922
—
AZ
01
—
2158173
PK
—
Enumeration date
01/19/2016
Last updated
04/02/2020
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