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General NPI Number Information
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NPI Number | 1528004132
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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 | 01/19/2009
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Provider Practice Location Address
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Address Line | 707 E SOUTH BOULDER RD
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City | LOUISVILLE
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State | CO
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Zip | 80027-1327
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Country | US
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Telephone | 303-665-2025
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Fax | 303-665-2829
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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 SPECIAIST
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0812
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License Number State | CO
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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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