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
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	700000003	CO

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	0612437	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1275570947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERTSONS LLC

Provider Business Mailing Address
First Line	:	3030 CULLERTON ST
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 W S BOULDER RD
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2708
Country	:	US
Telephone Number	:	303-665-7850
Fax Number	:	303-665-7584

Authorized Official
Title or Position	:	MANAGER PLAN IMPLEMENTATION
Name	:	JULIE SCHREINER
Credential	:
Telephone Number	:	847-916-4711

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	12/30/2008

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Directions to “ALBERTSONS LLC ” Practice Location

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