Organization
SAFEWAY INC
Active
Other names
Safeway Pharmacy #0245
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1044 WILLOW CREEK RD, PRESCOTT, AZ 86301
(928) 443-0300
(928) 443-0500
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
Y006107
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1990431
PK
—
05
—
479544
—
AZ
Enumeration date
07/02/2006
Last updated
03/09/2020
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