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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 Pharmacy7485FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11039723OTHEROTHER ID NUMBER
21039723OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1427096502
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALBERTSONS LLC
Provider Business Mailing Address
First Line : 3825 E BAY DR
Second Line :
City : LARGO
State : FL
Zip : 33771-1936
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3825 E BAY DR
Second Line :
City : LARGO
State : FL
Zip : 33771-1936
Country : US
Telephone Number : 727-535-1458
Fax Number : 727-530-4227
Authorized Official
Title or Position : NEW STORE ENROLLMENTS
Name : LORENZO TORRES
Credential :
Telephone Number : 847-916-4463
Provider Enumeration Date : 06/02/2006
Last Update Date : 11/21/2007

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Directions to “ALBERTSONS LLC ” Practice Location

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