Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1197
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1790 DECOTO RD, UNION CITY, CA 94587-3524
(510) 429-9093
(510) 429-7194
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
PHY52459
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952347544
—
CA
01
—
2000529
PK
—
Enumeration date
06/21/2006
Last updated
04/16/2020
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