Organization
ALBERTSONS LLC
Active
Other names
Sav-On Pharmacy #3859
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENT MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
200 E SEPULVEDA BLVD, CARSON, CA 90745-6323
(310) 513-6800
(310) 513-6580
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
PHY51325
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071PHA456890
—
CA
05
—
071PHA476180
—
CA
01
—
1998801
PK
—
Enumeration date
05/25/2006
Last updated
04/06/2020
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