NPIMap

Organization Active NPI

Safeway Inc

Doing business as Dominicks

  • Community/Retail Pharmacy
  • Crestwood, IL
National Provider Identifier
1083643050
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SAFEWAY INC
Doing business as
Dominicks
Practice address
13180 Cicero Ave
Crestwood, IL 60445-1470
Phone
(708) 385-4810
Fax
(708) 385-4653
NPI assigned
Jul 2, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Patrick Harris, CPHT MBA
Title
Managed Care Analyst
Phone
(623) 869-3778

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 54013028 IL
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

13180 Cicero Ave
Crestwood, IL 60445-1470

Mailing address

20427 N 27TH Ave MSC 4501
Phoenix, AZ 85027-3241

Other identifiers 1

IdentifierTypeStateIssuer
1460067OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • DOMINICKS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dominicks17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1083643050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20427 N 27TH AVE MSC 4501",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13180 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604451470",
            "telephone_number": "708-385-4810",
            "fax_number": "708-385-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "MANAGED CARE ANALYST",
        "authorized_official_telephone_number": "623-869-3778",
        "authorized_official_credential": "CPHT  MBA"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "54013028",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1460067",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOMINICKS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestwood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.