Active NPI
Safeway Inc
- Community/Retail Pharmacy
- Craig, CO
National Provider Identifier
1003845066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- SAFEWAY INC
- Doing business as
- SAFEWAY PHARMACY #0635
- Practice address
- 1295 W Victory Way
Craig, CO 81625-2943 - Phone
- (970) 824-8118
- Fax
- (970) 824-9517
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Managed Care, CPHT
- Title
- Managed Care Plan Specialist
- Phone
- (925) 467-2806
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 0276 | CO | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
1295 W Victory Way
Craig, CO 81625-2943
Mailing address
5918 Stoneridge Mall Rd
Pleasanton, CA 94588-3229
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0613263 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| P00229889 | Other | RAILROAD | |
| 03001369 | Medicaid | CO | |
| PHC015 | Other | FLU |
Other names 1
- SAFEWAY PHARMACY #0635
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040819001277 | TX | Part B Supplier - Centralized Flu Biller | 8628980299 |
This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
National Provider Directory
National Provider DirectoryMember of 3
Organizations this organization is a member of, according to the National Provider Directory.
-
- Community/Retail Pharmacy
- King of Prussia, PA
- NPI 1265659361
Member Of
Locations
1295 W Victory Way
Craig, CO 81625
Phone (970) 824-8118
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Boulder, CO
- NPI 1790085793
-
- Pharmacist
- Craig, CO
- NPI 1134497068
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151798400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1370390400000",
"number": "1003845066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5918 STONERIDGE MALL RD",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945883229",
"fax_number": "925-467-2802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1295 W VICTORY WAY",
"city": "CRAIG",
"state": "CO",
"postal_code": "816252943",
"telephone_number": "970-824-8118",
"fax_number": "970-824-9517"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAFEWAY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-02",
"last_updated": "2013-06-05",
"status": "A",
"authorized_official_last_name": "CARE",
"authorized_official_first_name": "MANAGED",
"authorized_official_title_or_position": "MANAGED CARE PLAN SPECIALIST",
"authorized_official_telephone_number": "925-467-2806",
"authorized_official_credential": "CPHT"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CO",
"license": "0276",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "0613263",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "P00229889",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03001369",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLU",
"identifier": "PHC015",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SAFEWAY PHARMACY #0635",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Craig, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.