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General NPI Number Information
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NPI Number | 1114973773
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Entity Type | Organization
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Legal Business Name | ALBERTSONS LLC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 18571 SOLEDAD CYN
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-3700
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Country | US
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Telephone | 661-298-0233
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Fax | 661-298-4912
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Provider Business Mailing Address
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Address Line | 250 E PARKCENTER BLVD QUARRY B BLDG
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City | BOISE
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State | ID
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Zip | 83706-3940
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Country | US
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Telephone | 208-395-3436
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Fax | 208-495-4503
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Authorized Official
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Title or Position | ASST MANAGER PLAN IMPLEMENTATION
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Name | DIONA TOWNSEND
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Credential |
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Telephone | 847-916-4513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY51322
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License Number State | CA
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