Organization
ALBERTSONS LLC
Active
Other names
Safeway Pharmacy #3542
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3954
Entity
Organization
Contact information
Practice address
14300 SW BARROWS RD, TIGARD, OR 97223-2063
(503) 590-0411
(503) 590-3804
Mailing address
250 E PARKCENTER BLVD, MS SEC2-B, BOISE, ID 83706-3940
(208) 395-3906
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0001617
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821443631
—
OR
01
—
2160032
PK
—
Enumeration date
04/29/2016
Last updated
09/23/2023
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