Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2809
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
13380 E MARY ANN CLEVELAND WAY, VAIL, AZ 85641
(925) 344-9020
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0361965
NCPDP PROVIDER NO
—
Enumeration date
12/18/2017
Last updated
04/14/2020
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