Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0024
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1003 E BROADWAY ST, MISSOULA, MT 59802-4971
(406) 549-6163
(406) 549-1786
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHA-PHR-LIC-14920
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891057634
—
MT
01
—
2135818
PK
—
Enumeration date
06/07/2012
Last updated
11/26/2025
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