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NPI Code Detail

MEDICARE: CARR-GOTTSTEIN FOODS CO

MEDICARE: CARR-GOTTSTEIN FOODS CO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy316AK
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20200078OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1578592515
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARR-GOTTSTEIN FOODS CO
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line :
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1650 W NORTHERN LIGHTS BLVD
Second Line :
City : ANCHORAGE
State : AK
Zip : 99517-3340
Country : US
Telephone Number : 907-339-0560
Fax Number : 907-339-0519
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 07/02/2006
Last Update Date : 03/04/2020

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1013527852 — CARR-GOTTSTEIN FOODS CO
Practice Location Address:
1650 W NORTHERN LIGHTS BLVD
ANCHORAGE, AK
99517-3340
Practice Phone: 907-339-0560
Practice Fax: 907-339-0519

Directions to “CARR-GOTTSTEIN FOODS CO ” Practice Location

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