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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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyPH01680NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12051590OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417903030
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALBERTSONS LLC
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 : 208-495-4503
Provider Business Practice Location Address
First Line : 7151 W CRAIG RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-6511
Country : US
Telephone Number : 702-839-9256
Fax Number : 702-839-9485
Authorized Official
Title or Position : ENROLLMENT MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 05/25/2006
Last Update Date : 04/02/2020

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Directions to “ALBERTSONS LLC ” Practice Location

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