Organization
ALBERTSONS LLC
Active
Other names
Sav-On Pharmacy #3174
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1901 S 2500 E, AMMON, ID 83406
(208) 524-1616
(208) 528-6563
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
21055RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002256100
—
ID
01
—
2021074
PK
—
05
—
807494800
—
ID
Enumeration date
05/30/2006
Last updated
04/03/2020
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