Active NPI
Albertsons LLC
Doing business as Sav-on Pharmacy #0599
- Community/Retail Pharmacy
- Upland, CA
National Provider Identifier
1124572631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY55405
- Legal business name
- ALBERTSONS LLC
- Doing business as
- Sav-on Pharmacy #0599
- Practice address
- 1910 N Campus Ave
Upland, CA 91784-1667 - Phone
- (909) 946-3340
- Fax
- (909) 946-0052
- NPI assigned
- Aug 12, 2016
- Last updated
- Apr 3, 2020
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | PHY55405 | CA | Primary |
Addresses
Primary practice location
1910 N Campus Ave
Upland, CA 91784-1667
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2163650 | Other | PK | |
| 1124572631 | Medicaid | CA |
Other names 1
- SAV-ON PHARMACY #0599
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130805000820 | CA | DME Supplier - Pharmacy | 8729983515 |
1 other NPI on this enrollment Practice locations: Upland, CA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2186687 | Sav-on Pharmacy #0599 | Certificate of waiver | Jun 18, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Sav-on Pharmacy #0599 | 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 |
National Provider Directory
National Provider Directory- Tax ID family
- Albertsons Inc 4103
Organizations with this tax ID in the same state 23
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470960000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1585872000000",
"number": "1124572631",
"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": "1910 N CAMPUS AVE",
"city": "UPLAND",
"state": "CA",
"postal_code": "917841667",
"telephone_number": "909-946-3340",
"fax_number": "909-946-0052"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALBERTSONS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-08-12",
"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": "CA",
"license": "PHY55405",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2163650",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1124572631",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SAV-ON PHARMACY #0599",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Upland, CA
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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.