Organization
SAFEWAY INC
Active
Other names
Safeway Pharmacy #0055
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
19555 S MOUNTAIN HOUSE PKWY, MOUNTAIN HOUSE, CA 95391
(209) 362-1261
(209) 362-1260
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
—
—
Other
Enumeration date
05/11/2022
Last updated
11/16/2022
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