NPIMap

Organization Active NPI

Albertsons LLC

Doing business as Safeway Pharmacy #0840

  • Community/Retail Pharmacy
  • Colorado Springs, CO
National Provider Identifier
1073550745
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
240000123 Issued in CO
Legal business name
ALBERTSONS LLC
Doing business as
Safeway Pharmacy #0840
Practice address
8750 N Union Blvd
Colorado Springs, CO 80920-7797
Phone
(719) 282-9502
Fax
(719) 282-9553
NPI assigned
Jun 1, 2006
Last updated
Apr 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 240000123 CO Primary

Addresses

Primary practice location

8750 N Union Blvd
Colorado Springs, CO 80920-7797

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 2

IdentifierTypeStateIssuer
2003492OtherPK
46525734MedicaidCO

Other names 1

  • SAFEWAY PHARMACY #0840 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041014000405 TX Part B Supplier - Centralized Flu Biller 8729983515 This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID
O20100930096722 CO DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Colorado Springs, CO

National Provider Directory

National Provider Directory

Member of 3

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

Locations

8750 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 282-9502

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1073550745",
    "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": "8750 N UNION BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207797",
            "telephone_number": "719-282-9502",
            "fax_number": "719-282-9553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "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": "CO",
            "license": "240000123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2003492",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46525734",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #0840",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.