Organization
SAFEWAY INC
Active
Other names
Safeway Pharmacy #3120
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
12725 1ST AVE S, BURIEN, WA 98168-2683
(206) 566-7303
(206) 566-7306
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
PHAR.CF.60629331
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2060335
—
WA
01
—
2156210
PK
—
Enumeration date
12/22/2015
Last updated
04/28/2020
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