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General NPI Number Information
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NPI Number | 1699706499
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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 | 07/06/2006
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 6911 COAL CREEK PKWY SE
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City | NEWCASTLE
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State | WA
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Zip | 98059-3136
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Country | US
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Telephone | 425-644-2726
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Fax | 425-643-9771
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Provider Business Mailing Address
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Address Line | 250 E PARKCENTER BLVD
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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 |
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Fax |
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Authorized Official
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Title or Position | ENROLLMENTS MANAGER
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Name | KATHY GIANNAKOPOULOS
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Credential |
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Telephone | 208-395-3954
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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 | PHAR.CF.60515991
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License Number State | WA
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