Healthcare Provider Details

I. General information

NPI: 1134166689
Provider Name (Legal Business Name): ALBERTSONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 N HOBART ST
PAMPA TX
79065-4605
US

IV. Provider business mailing address

1223 N HOBART ST
PAMPA TX
79065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 806-669-2564
  • Fax: 806-665-6494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number14612
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. LORENZO TORRES III
Title or Position: NEW STORE ENROLLMENTS
Credential:
Phone: 847-916-4463