Organization
ALBERTSONS LLC
Active
Other names
OSCO PHARMACY #2061
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1825 17TH ST, CODY, WY 82414-4701
(307) 527-7426
(307) 527-7435
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
R10096
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125396400
—
WY
01
—
2111696
PK
—
Enumeration date
12/19/2007
Last updated
04/03/2020
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