Safeway Inc
Organization Active NPI Community/Retail Pharmacy · Willcox, AZ
NPI 1184653131 · NPPES record last updated Mar 12, 2020
Key facts
- NPI
- 1184653131
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- Y006212 (AZ)
- Legal business name
- SAFEWAY INC
- Practice address
- 650 N Bisbee Ave
Willcox, AZ 85643-1437 - Phone
- (520) 384-4612
- Fax
- (520) 384-0535
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Member of 3
Practitioners 5
-
Nickalaus David Bryce, PHARMD
-
Larry Ray Hamel Jr., R. PH.
-
David Kenneth Hill, PHARMACIST
-
Peter Orzech, S12854
-
Marta Parrs, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2073002 | Safeway Pharmacy #0272 | Certificate of waiver | Feb 22, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Safeway Pharmacy #0272 |
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|Diabetic Shoes and Inserts | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040819001277 | TX | Part B Supplier - Centralized Flu Biller | 8628980299 |
This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
| O20100930012865 | AZ | DME Supplier - Pharmacy |
8628980299 | Practice locations: Willcox, AZ |
National Provider Directory
Locations
650 N Bisbee Ave
Willcox, AZ 85643
Phone (520) 384-4612
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Y006212 | AZ | Yes |
Addresses
Primary practice location
650 N Bisbee Ave
Willcox, AZ 85643-1437
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Phone (208) 395-6200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1989467 | Other | PK | |
| 119447 | Medicaid | AZ |
Other names
- SAFEWAY PHARMACY #0272
Other providers in Willcox, AZ
- Marta Parrs
- Michael Payne
- Pima Heart Physicians, PC
- Susan Woods Poire
- Martha Prendergast
- Ellen Schaeffer
- Margaret Anne Schrader
- Charles Schroll
- Sherry'S Adult Care Homes,LLC
- Victoria Helene Singer
All providers in Willcox, AZ · Community/Retail Pharmacy in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.