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	333600000X	Pharmacy	198	CO
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0612970	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	P00229889	OTHER	CO	RR #
3	PHC015	OTHER	CO	FLU #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285663237
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	:	4860 PECOS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-1513
Country	:	US
Telephone Number	:	303-433-5083
Fax Number	:	303-477-9539

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	:	12/11/2008

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Directions to “SAFEWAY INC ” Practice Location

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