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General NPI Number Information
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NPI Number | 1205872819
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Entity Type | Organization
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Legal Business Name | SAFEWAY INC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 4600 COOPER LN
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City | LANDOVER HILLS
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State | MD
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Zip | 20784-1327
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Country | US
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Telephone | 301-341-2726
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Fax | 301-341-9215
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Provider Business Mailing Address
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Address Line | 20427 N 27TH AVE # MSC4551
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City | PHOENIX
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State | AZ
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Zip | 85027-3241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE PLAN SPECIALIST
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Name | MICHELLE ANN RIVERS
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Credential | CPHT
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Telephone | 623-869-3524
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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 | P01546
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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