NPIMap

Organization Active NPI

Albertsons LLC

  • Community/Retail Pharmacy
  • Phoenix, AZ
National Provider Identifier
1245277672
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y04584 Issued in AZ
Legal business name
ALBERTSONS LLC
Doing business as
Osco Drug #2985
Practice address
18411 N Cave Creek Rd
Phoenix, AZ 85032-1099
Phone
(602) 494-7424
Fax
(602) 494-7520
NPI assigned
Jun 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Y04584 AZ Primary

Addresses

Primary practice location

18411 N Cave Creek Rd
Phoenix, AZ 85032-1099

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 2

IdentifierTypeStateIssuer
1990034OtherPK
099770MedicaidAZ

Other names 1

  • Osco Drug #2985 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments

Enrollment records 2

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
O20100930001764 AZ DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Member of 3

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

Locations

18411 N Cave Creek Rd
Phoenix, AZ 85032
Phone (602) 494-7424

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1245277672",
    "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": "18411 N CAVE CREEK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850321099",
            "telephone_number": "602-494-7424",
            "fax_number": "602-494-7520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "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": "AZ",
            "license": "Y04584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1990034",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099770",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Osco Drug #2985",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Osco Drug #2985",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.