Safeway Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SAFEWAY INC

Doing business as

Safeway Pharmacy #4711

Practice address

1900 Woodland Dr
Coos Bay, OR 97420-2045

Phone

(541) 266-7542

Fax

(541) 266-7638

NPI assigned

Dec 29, 2008

Last updated

May 20, 2010By 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

Michelle Rivers

Title

Managed Care Plan Specialist

Phone

(623) 869-3524

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Safeway Pharmacy #4711 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Member of 3

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

• Genuardi's Family Markets LP GFM

  dba Genuardi's Pharmacy #1005

  • Community/Retail Pharmacy
  • Maple Glen, PA
  • NPI 1801034640

  Member Of

  NPD member
• Randalls Food & Drugs LP

  dba Randalls Pharmacy #1896

  • Community/Retail Pharmacy
  • Cedar Park, TX
  • NPI 1356387971

  Member Of

  NPD member
• Vons Companies Inc

  dba Vons Pharmacy #2200

  • Community/Retail Pharmacy
  • Monrovia, CA
  • NPI 1376589986

  Member Of

  NPD member

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

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1053557801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20427 N 27TH AVE # MS 4551",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273241",
            "telephone_number": "623-869-3524",
            "fax_number": "623-869-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202045",
            "telephone_number": "541-266-7542",
            "fax_number": "541-266-7638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-29",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "RIVERS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "MANAGED CARE PLAN SPECIALIST",
        "authorized_official_telephone_number": "623-869-3524"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053557801",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3843441",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Safeway Pharmacy #4711",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caitlin Belle Rowley
• David Keven Rudder
• Gina Rushton, RN
• Leslie Ryan, MS, QMHA
• Alyssa Sader, M.D.
• Safeway Inc (Safeway Pharmacy #1556)
• Nicholas Brandon Sanchez, CHW
• Steven C Sanden, CADC I, CRM, PWS
• Linda Schartman, MA, LPC
• Demitra Rhea Schmidt

• Community/Retail Pharmacy in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Community/Retail Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; 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.