Organization
SAFEWAY INC
Active
Other names
SAFEWAY PHARMACY #1879
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
555 E CALAVERAS BLVD, MILPITAS, CA 95035-7704
(408) 262-9855
(408) 262-9859
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
(208) 395-3963
(623) 336-6896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52302
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982823282
—
CA
01
—
2112337
PK
—
Enumeration date
04/25/2007
Last updated
04/06/2020
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