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General NPI Number Information
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NPI Number | 1093051104
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Entity Type | Organization
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Legal Business Name | SAFEWAY PHARMACY
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 212 ELKS POINT RD
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City | ZEPHYR COVE
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State | NV
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Zip | 89448-8001
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Country | US
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Telephone | 775-586-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 757 LIPIZZAN RD
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City | DAYTON
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State | NV
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Zip | 89403-6408
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Country | US
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Telephone | 435-590-4459
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. GREG PONSNES
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Credential | PHARMD
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Telephone | 775-586-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1540361701
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14673
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License Number State | NV
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