Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #0009
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
6999 JACKRABBIT LN, BELGRADE, MT 59714-8961
(406) 388-1696
(406) 388-1737
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
PHA-PHR-LIC-14951
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0210307
—
MT
05
—
0214659
—
MT
01
—
2051937
PK
—
Enumeration date
05/25/2006
Last updated
04/01/2020
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