Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1803
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
717 STATE ROUTE 9 NE, LAKE STEVENS, WA 98258-7992
(425) 249-4002
(425) 249-4016
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
05
—
PENDING
—
WA
Enumeration date
10/19/2018
Last updated
12/27/2018
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