Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #2817
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
232 G ST, SALIDA, CO 81201-2019
(719) 539-6933
(719) 539-1538
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-6200
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1090000004
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03002714
—
CO
01
—
2002711
PK
—
Enumeration date
06/21/2006
Last updated
04/08/2020
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