NPIMap

Organization Active NPI

Albertsons LLC

Doing business as Osco Drug

  • Community/Retail Pharmacy
  • Casa Grande, AZ
National Provider Identifier
1215976691
Registry record updated Dec 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y04570 Issued in AZ
Legal business name
ALBERTSONS LLC
Doing business as
Osco Drug
Practice address
1116 E Florence Blvd
Casa Grande, AZ 85122-4216
Phone
(520) 421-9920
Fax
(520) 421-2874
NPI assigned
Jun 4, 2006
Last updated
Dec 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2010

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

Authorized official

Name
Dan Johnson
Title
Manager Managed Healthcare
Phone
(208) 395-3436

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Y04570 AZ Primary

Addresses

Primary practice location

1116 E Florence Blvd
Casa Grande, AZ 85122-4216

Mailing address

3030 Cullerton St
Franklin Park, IL 60131-2205

Other identifiers 2

IdentifierTypeStateIssuer
0321454OtherNCPDP PROVIDER IDENTIFICATION NUMBER
100036MedicaidAZ

Other names 1

  • OSCO DRUG Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041014000405 TX Part B Supplier - Centralized Flu Biller 8729983515 This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Member of 3

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

Locations

1116 E Florence Blvd
Casa Grande, AZ 85122
Phone (520) 421-7170

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291334400000",
    "number": "1215976691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 CULLERTON ST",
            "city": "FRANKLIN PARK",
            "state": "IL",
            "postal_code": "601312205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 E FLORENCE BLVD",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851224216",
            "telephone_number": "520-421-9920",
            "fax_number": "520-421-2874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2010-12-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "MANAGER MANAGED HEALTHCARE",
        "authorized_official_telephone_number": "208-395-3436"
    },
    "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": "AZ",
            "license": "Y04570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0321454",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100036",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSCO DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Casa Grande, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.