Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Hayden, ID
NPI 1194771600 · NPPES record last updated Apr 4, 2024
Key facts
- NPI
- 1194771600
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 21048RP (ID)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 161 W Prairie Ave
Hayden, ID 83835 - Phone
- (208) 772-7864
- Fax
- (208) 772-7905
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollment Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 21
Member of 7
Practitioners 4
-
Ashley Marie Golden, PHARM.D.
-
Kimberly Marie Westrick, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D1036468 | Safeway Pharmacy #0254 | Certificate of waiver | Feb 3, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Safeway Pharmacy #254 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130711000413 | ID | DME Supplier - Pharmacy |
8729983515 | Practice locations: Hayden, ID |
National Provider Directory
- Tax ID family
- Albertsons 851
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 21048RP | ID | Yes |
Addresses
Primary practice location
161 W Prairie Ave
Hayden, ID 83835
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 804296700 | Medicaid | ID | |
| 2021444 | Other | PK | |
| 807493900 | Medicaid | ID |
Other names
- Safeway Pharmacy #0254
Other providers in Hayden, ID
- A New Horizon Counseling Service, LLC
- Sarah Adair
- Adam J Olscamp MD PC
- Daniel Leo Adams
- Jonathan T Adams
- Alysha Summer Allen
- Holly B Alling
- Kailyn Alt
- Amaris Associates, PLLC
- Shannon Andrews
All providers in Hayden, ID · Community/Retail Pharmacy in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2024. 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.