Organization
SHAWS SUPERMARKETS
Active
Other names
Shaws Pharmacy #3577
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3932
Entity
Organization
Contact information
Practice address
75 SPRING ST, WEST ROXBURY, MA 02132
(617) 327-9360
(617) 327-2938
Mailing address
250 E PARKCENTER BLVD, MAILSTOP SEC2-B, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
DS3163
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110000003J
—
MA
01
—
2037751
PK
—
Enumeration date
05/25/2006
Last updated
07/08/2024
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