MEDICARE: SAFEWAY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies	201002358	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4820280	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1043256662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY INC

Provider Business Mailing Address
First Line	:	20427 N 27TH AVE # MSC4551
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6118 ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2901
Country	:	US
Telephone Number	:	703-241-4126
Fax Number	:	703-536-4651

Authorized Official
Title or Position	:	MANAGED CARE PLAN SPECIALIST
Name	:	MICHELLE A RIVERS
Credential	:	CPHT
Telephone Number	:	623-869-3524

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	11/10/2008

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Directions to “SAFEWAY INC ” Practice Location

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