Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1486
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
611 N MONTANA AVE, HELENA, MT 59601-3827
(406) 443-4508
(406) 443-3517
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
PHA-PHR-LIC-27833
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000231361
—
MT
05
—
0005602285
—
MT
01
—
2050388
PK
—
Enumeration date
07/02/2006
Last updated
04/21/2020
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