Healthcare Provider Details

I. General information

NPI: 1346280716
Provider Name (Legal Business Name): ALBERTSONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 E GREENWAY RD
PHOENIX AZ
85032-4818
US

IV. Provider business mailing address

3030 CULLERTON ST
FRANKLIN PARK IL
60131-2205
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-6005
  • Fax: 602-788-6923
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY04558
License Number StateAZ

VIII. Authorized Official

Name: DIONA TOWNSEND
Title or Position: ASST MGR PLAN IMPLEMENTATION
Credential:
Phone: 847-916-4513