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NPI Code Detail

MEDICARE: ALBERTSONS LLC

MEDICARE: ALBERTSONS LLC
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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy5203423WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15203423OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
25203423OTHEROTHER ID NUMBER

General Provider Information

NPI Number : 1114964665
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALBERTSONS LLC
Provider Business Mailing Address
First Line : 3112 E GRAND AVE
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5141
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3112 E GRAND AVE
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5141
Country : US
Telephone Number : 307-745-7246
Fax Number : 307-742-7392
Authorized Official
Title or Position : NEW STORE ENROLLMENTS
Name : LORENZO TORRES
Credential :
Telephone Number : 847-916-4463
Provider Enumeration Date : 06/01/2006
Last Update Date : 11/21/2007

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Directions to “ALBERTSONS LLC ” Practice Location

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