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General NPI Number Information
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NPI Number | 1568498335
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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 | 06/24/2006
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 415 N MAIN AVE
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City | AZTEC
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State | NM
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Zip | 87410-1927
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Country | US
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Telephone | 505-334-6261
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Fax | 505-334-6853
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Provider Business Mailing Address
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Address Line | 250 E PARKCENTER BLVD MAILSTOP SEC2-B
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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 | 208-395-3963
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Fax | 623-336-6896
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Authorized Official
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Title or Position | ASSISTANT MANAGER, ENROLLMENTS
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Name | TIFFANY ELIOPULOS
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Credential |
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Telephone | 208-395-3906
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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 |
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License Number State |
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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 | PH00003867
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License Number State | NM
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