Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Idaho Falls, ID
NPI 1023064946 · NPPES record last updated Apr 2, 2020
Key facts
- NPI
- 1023064946
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 21051RP (ID)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 590 E 17TH St
Idaho Falls, ID 83404 - Phone
- (208) 523-1090
- Fax
- (208) 528-8681
- NPI assigned
- May 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollment Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 14
Member of 7
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D1035616 | Sav-on Pharmacy #0138 | Certificate of waiver | Jan 5, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Sav-on Pharmacy #138 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130712000484 | ID | DME Supplier - Pharmacy |
8729983515 | Practice locations: Idaho Falls, ID |
National Provider Directory
- Tax ID family
- Albertsons 851
Locations
590 E 17th St
Idaho Falls, ID 83404
Phone (208) 523-1090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 21051RP | ID | Yes |
Addresses
Primary practice location
590 E 17TH St
Idaho Falls, ID 83404
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2020343 | Other | PK | |
| 002256800 | Medicaid | ID | |
| 807496000 | Medicaid | ID |
Other names
- SAV-ON PHARMACY #0138
Other providers in Idaho Falls, ID
- Agewell Connections LLC.
- Agewell Transportation LLC
- Ashley Kyle Aiton
- Alan Adamson, OD, PC
- Jessica Alba
- Sherie Leigh Albrecht
- Warren E Albrecht
- Taten Lee Albright
- Kristen Alderson
- Nichole Aldinger
All providers in Idaho Falls, ID · Community/Retail Pharmacy in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.