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NPI Code Detail

MEDICARE: SAFEWAY INC

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPHAR.CF.60629339WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22158269OTHERPK

General Provider Information

NPI Number : 1790140572
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAFEWAY INC
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line :
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number : 208-395-3963
Fax Number : 623-336-6896
Provider Business Practice Location Address
First Line : 3355 BETHEL RD SE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-5635
Country : US
Telephone Number : 360-329-5465
Fax Number : 360-329-5469
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 12/22/2015
Last Update Date : 04/13/2020

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Directions to “SAFEWAY INC ” Practice Location

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