MEDICARE: SAFEWAY PHARMACY

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
1	305S00000X	Point of Service	3336C0003X	NE

General Provider Information

NPI Number	:	1811331762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY PHARMACY

Provider Business Mailing Address
First Line	:	500 E 3RD ST
Second Line	:
City	:	ALLIANCE
State	:	NE
Zip	:	69301-3832
Country	:	US
Telephone Number	:	308-762-1258
Fax Number	:	308-762-2126

Provider Business Practice Location Address
First Line	:	4246 450TH RD
Second Line	:
City	:	HAY SPRINGS
State	:	NE
Zip	:	69347-4236
Country	:	US
Telephone Number	:	308-232-4576
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MARY CRUM
Credential	:
Telephone Number	:	308-762-1258

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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Directions to “SAFEWAY PHARMACY ” Practice Location

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