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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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1063042083
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAFEWAY INC
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line :
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3383 BASS LAKE RD
Second Line :
City : EL DORADO HILLS
State : CA
Zip : 95762
Country : US
Telephone Number : 530-313-4925
Fax Number : 503-313-4926
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 01/17/2020
Last Update Date : 01/17/2020

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Directions to “SAFEWAY INC ” Practice Location

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