Healthcare Provider Details

I. General information

NPI: 1285099283
Provider Name (Legal Business Name): SAFEWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 S YOSEMITE ST
CENTENNIAL CO
80112-1412
US

IV. Provider business mailing address

6900 S YOSEMITE ST
CENTENNIAL CO
80112-1412
US

V. Phone/Fax

Practice location:
  • Phone: 303-843-7797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA.0021107
License Number StateCO

VIII. Authorized Official

Name: MELANIE PICKETT
Title or Position: PHARMACY COORDINATOR
Credential:
Phone: 303-843-7797