NPIMap

Organization Active NPI

Albertsons LLC

  • Community/Retail Pharmacy
  • El Cajon, CA
National Provider Identifier
1174988901
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
54327 Issued in CA
Legal business name
ALBERTSONS LLC
Practice address
1608 Broadway
El Cajon, CA 92021-5201
Phone
(619) 579-3463
Fax
(619) 442-5841
NPI assigned
Dec 21, 2015
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kathy Giannakopoulos
Title
Enrollment Manager
Phone
(208) 395-3954

Corporate family (same tax ID) 24

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

View all 24

Member of 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2142622Sav-on Pharmacy #32021608 Broadway St, El Cajon, CA 92021Certificate of waiverAug 3, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Sav-on Pharmacy #32021608 Broadway, El Cajon, CA 92021-5201(619) 579-3463 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 assignmentParticipating since Jan 1, 2001

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20160512001069 CA DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: El Cajon, CA

National Provider Directory

National Provider Directory
Tax ID family
Albertsons 851 (386 organizations share this tax ID)

Locations

1608 Broadway
El Cajon, CA 92021
Phone (619) 579-3463

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 54327 CA Primary

Addresses

NPPES NPI Registry

Primary practice location

1608 Broadway
El Cajon, CA 92021-5201

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
2157264OtherPK
1174988901MedicaidCA

Other names 1

NPPES NPI Registry
  • Sav-On Pharmacy #3202 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 3, 2020.

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1174988901",
    "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": "1608 BROADWAY",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920215201",
            "telephone_number": "619-579-3463",
            "fax_number": "619-442-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-21",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "54327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157264",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174988901",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sav-On Pharmacy #3202",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sav-On Pharmacy #3202",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Cajon, 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.

Verify at the official NPI Registry.