Healthcare Provider Details

I. General information

NPI: 1184839243
Provider Name (Legal Business Name): SAFEWAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20427 N 27TH AVE # MSC 4501
PHOENIX AZ
85027-3241
US

IV. Provider business mailing address

20427 N 27TH AVE # MS 4501
PHOENIX AZ
85027-3241
US

V. Phone/Fax

Practice location:
  • Phone: 623-869-3524
  • Fax: 623-869-1232
Mailing address:
  • Phone: 623-869-3524
  • Fax: 623-869-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE ANN RIVERS
Title or Position: MANAGED CARE PLAN SPECIALIST
Credential:
Phone: 623-869-3524