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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
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0003XCommunity/Retail Pharmacy17384TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12106618OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740228162
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 :
Provider Business Practice Location Address
First Line : 1155 N MAIN ST
Second Line :
City : EULESS
State : TX
Zip : 76039-2757
Country : US
Telephone Number : 817-354-2427
Fax Number : 817-354-9724
Authorized Official
Title or Position : ENROLLMENT MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 06/04/2006
Last Update Date : 06/16/2025

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Directions to “ALBERTSONS LLC ” Practice Location

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