Organization
SAFEWAY INC
Active
Other names
Safeway Pharmacy #1135
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ELIOPULOS (ASSISTANT MANAGER, ENROLLMENTS)
(208) 395-3906
Entity
Organization
Contact information
Practice address
804 W 1ST ST, CLE ELUM, WA 98922-1012
(509) 852-3006
(509) 852-3010
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
Primary
PHAR.CF.60720388
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2073901
—
WA
01
—
2166698
PK
—
Enumeration date
12/07/2016
Last updated
10/22/2018
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