Healthcare Provider Details

I. General information

NPI: 1427084201
Provider Name (Legal Business Name): SAFEWAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9517 RALSTON RD
ARVADA CO
80002
US

IV. Provider business mailing address

5918 STONERIDGE MALL RD
PLEASANTON CA
94588-3229
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-7361
  • Fax: 303-456-4644
Mailing address:
  • Phone:
  • Fax: 925-467-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number40000014
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MANAGED CARE
Title or Position: MANAGED CARE PLAN SPECIALIST
Credential: CPHT
Phone: 925-467-2806