Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1743
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
980 US HIGHWAY 491, GALLUP, NM 87301-5339
(505) 722-9977
(505) 722-8481
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003870
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133285
PK
—
05
—
38980088
—
NM
05
—
696898
—
AZ
Enumeration date
01/04/2012
Last updated
04/03/2020
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