Organization
ALBERTSONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
9595 E BROADWAY BLVD, TUCSON, AZ 85748-3210
(520) 751-7549
(520) 733-3796
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y04566
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100135
—
AZ
01
—
1989701
PK
—
Enumeration date
06/04/2006
Last updated
04/06/2020
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