NPIMap

Organization Active NPI

Albertsons LLC

  • Community/Retail Pharmacy
  • Cheyenne, WY
National Provider Identifier
1043494545
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
R10123 Issued in WY
Legal business name
ALBERTSONS LLC
Practice address
3355 E Pershing Blvd
Cheyenne, WY 82001-5764
Phone
(307) 635-1155
Fax
(307) 632-5657
NPI assigned
Dec 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

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

Authorized official

Name
Tiffany Eliopulos
Title
Assistant Manager, Enrollments
Phone
(208) 395-3906

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X R10123 WY Primary

Addresses

Primary practice location

3355 E Pershing Blvd
Cheyenne, WY 82001-5764

Mailing address

250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83706-3940
Phone (847) 916-4463

Other identifiers 2

IdentifierTypeStateIssuer
125401400MedicaidWY
2111698OtherPK

Other names 1

  • OSCO PHARMACY #0065 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130801000053 WY DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Cheyenne, WY

National Provider Directory

National Provider Directory
Tax ID family
Albertsons 851386 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Member of 7

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

NPI Registry JSON

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536624000000",
    "number": "1043494545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "address_2": "MAILSTOP SEC2-B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940",
            "telephone_number": "847-916-4463",
            "fax_number": "847-916-4736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 E PERSHING BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820015764",
            "telephone_number": "307-635-1155",
            "fax_number": "307-632-5657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2018-09-11",
        "status": "A",
        "authorized_official_last_name": "ELIOPULOS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ASSISTANT MANAGER, ENROLLMENTS",
        "authorized_official_telephone_number": "208-395-3906"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WY",
            "license": "R10123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125401400",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2111698",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSCO PHARMACY #0065",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OSCO PHARMACY #0065",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; 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.

Verify at the official NPI Registry.