Albertsons LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

AR17558 Issued in AR

Legal business name

ALBERTSONS LLC

Doing business as

Albertsons Pharmacy #0611

Practice address

3710 N State Line Ave
Texarkana, AR 71854-1934

Phone

(870) 773-5521

Fax

(870) 774-8426

NPI assigned

Jun 4, 2006

Last updated

Aug 21, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathy Giannakopoulos

Title

Enrollment Manager

Phone

(208) 395-3954

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• ALBERTSONS PHARMACY #0611 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX, AR2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Safeway Inc

  dba Safeway Phamracy #4837

  • Community/Retail Pharmacy
  • District Heights, MD
  • NPI 1588600191

  Member Of

  NPD member
• Star Markets Company Inc

  dba Shaws Pharmacy #2594

  • Community/Retail Pharmacy
  • Marshfield, MA
  • NPI 1548216070

  Member Of

  NPD member
• United Supermarkets LLC

  dba Albertsons Market Pharmacy #0904

  • Community/Retail Pharmacy
  • Albuquerque, NM
  • NPI 1124067509

  Member Of

  NPD member

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Denise Calhoon, PHARMD

  • Pharmacist
  • Texarkana, AR
  • NPI 1881096485
  NPD (past)
• Millard Formby III

  • Pharmacist
  • Texarkana, AR
  • NPI 1982469847
  NPD (past)
• Jennifer Hammett, RPH

  • Pharmacist
  • Texarkana, AR
  • NPI 1760843940
  NPD (past)
• Austin Sewell

  • Ambulatory Care Pharmacist
  • Texarkana, AR
  • NPI 1114670189
  NPD (past)
• SE Hee Song

  • Pharmacist
  • Texarkana, AR
  • NPI 1245146646
  NPD (past)
• Amanda Carol Keith, PHARM.D.

  • Pharmacist
  • Texarkana, TX
  • NPI 1942661129
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1013956499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 N STATE LINE AVE",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541934",
            "telephone_number": "870-773-5521",
            "fax_number": "870-774-8426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "208-395-3954"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AR",
            "license": "AR17558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121367407",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1995178",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALBERTSONS PHARMACY #0611",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Texarkana, AR
• Providers in Texarkana, AR by specialty
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.