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NPI Code Detail

MEDICARE: SAFEWAY INC

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
1333600000XPharmacyP02196MD
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12122149OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053340075
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 : 5000 BRADLEY BLVD
Second Line :
City : BETHESDA
State : MD
Zip : 20815-6559
Country : US
Telephone Number : 301-913-5666
Fax Number : 301-913-5670
Authorized Official
Title or Position : MANAGED CARE PLAN SPECIALIST
Name : MICHELLE ANN RIVERS
Credential : CPHT
Telephone Number : 623-869-3524
Provider Enumeration Date : 07/02/2006
Last Update Date : 12/16/2008

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Directions to “SAFEWAY INC ” Practice Location

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