NPIMap

Organization Active NPI

Albertsons LLC

  • Community/Retail Pharmacy
  • Fort Worth, TX
National Provider Identifier
1225075773
Registry record updated Nov 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
13846 Issued in TX
Legal business name
ALBERTSONS LLC
Practice address
4650 SW Loop 820
Fort Worth, TX 76109-4429
Phone
(817) 738-3491
Fax
(817) 732-1485
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2009

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 13846 TX Primary

Addresses

Primary practice location

4650 SW Loop 820
Fort Worth, TX 76109-4429

Mailing address

3030 Cullerton St
Franklin Park, IL 60131-2205

Other identifiers 2

IdentifierTypeStateIssuer
4582450OtherNCPDP PROVIDER IDENTIFICATION NUMBER
463243MedicaidTX

Other names 1

  • SAVON PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Albertsons 851386 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

Locations

4650 SW Loop 820
Fort Worth, TX 76109
Phone (817) 738-3491

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259107200000",
    "number": "1225075773",
    "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": "4650 SW LOOP 820",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094429",
            "telephone_number": "817-738-3491",
            "fax_number": "817-732-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2009-11-25",
        "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": "TX",
            "license": "13846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4582450",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463243",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAVON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.