Organization
ALBERTSONS LLC
Active
Other names
Osco Drug #3926
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
12970 W INDIAN SCHOOL RD, LITCHFIELD PARK, AZ 85340-5153
(623) 535-7153
(623) 535-7920
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
Y04545
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100829
—
AZ
01
—
1991610
PK
—
Enumeration date
06/02/2006
Last updated
04/06/2020
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