Healthcare Provider Details

I. General information

NPI: 1396625844
Provider Name (Legal Business Name): SAFEWAY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 MOUNT TAMALPAIS DR
ROSEVILLE CA
95747-7147
US

IV. Provider business mailing address

3252 MOUNT TAMALPAIS DR
ROSEVILLE CA
95747-7147
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIA MOHAMMAD RAYYAN
Title or Position: PHARMACIST
Credential:
Phone: --