Organization
CARR-GOTTSTEIN FOODS CO
Active
Other names
SAFEWAY PHARMACY #1833
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
109 E PIONEER DR, VALDEZ, AK 99686
(907) 835-3737
(907) 835-5757
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
120107
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1635211
—
AK
05
—
1636871
—
AK
01
—
2153492
PK
—
Enumeration date
07/28/2015
Last updated
03/04/2020
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