NPIMap

Organization Active NPI

Safeway Inc

  • Community/Retail Pharmacy
  • Anthem, AZ
National Provider Identifier
1255883161
Registry record updated Apr 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y007058 Issued in AZ
Legal business name
SAFEWAY INC
Practice address
3655 W Anthem Way
Anthem, AZ 85086-0430
Phone
(623) 745-3805
Fax
(623) 745-3810
NPI assigned
Oct 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2020

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Y007058 AZ Primary

Addresses

Primary practice location

3655 W Anthem Way
Anthem, AZ 85086-0430

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940
Phone (208) 395-6200

Other identifiers 2

IdentifierTypeStateIssuer
224201MedicaidAZ
2165904OtherPK

Other names 1

  • Safeway Pharmacy #3334 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170303000088 AZ DME Supplier - PharmacyDME Supplier - Grocery Store 8628980299 Practice locations: Anthem, AZ

National Provider Directory

National Provider Directory
Tax ID family
Safeway Pharmacy 107370 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 10

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

Member of 3

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

NPI Registry JSON

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

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586736000000",
    "number": "1255883161",
    "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",
            "telephone_number": "208-395-6200",
            "fax_number": "623-336-6896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 W ANTHEM WAY",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850860430",
            "telephone_number": "623-745-3805",
            "fax_number": "623-745-3810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-26",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ENROLLMENTS 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": "Y007058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "224201",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2165904",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Safeway Pharmacy #3334",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Safeway Pharmacy #3334",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anthem, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.