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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 Pharmacy11247FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11065300OTHEROTHER ID NUMBER
21065300OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1326085093
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALBERTSONS LLC
Provider Business Mailing Address
First Line : 610 EGLIN PKWY NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-2832
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 610 EGLIN PKWY NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-2832
Country : US
Telephone Number : 850-864-4446
Fax Number : 850-864-4497
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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