NPIMap

Organization Active NPI

Albertsons LLC

  • Community/Retail Pharmacy
  • Lake Havasu City, AZ
National Provider Identifier
1346605185
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y006761 Issued in AZ
Legal business name
ALBERTSONS LLC
Doing business as
Albertsons Pharmacy #3204
Practice address
1980 McCulloch Blvd N
Lake Havasu City, AZ 86403-0969
Phone
(928) 854-8281
Fax
(928) 453-3969
NPI assigned
Dec 21, 2015
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 Y006761 AZ Primary

Addresses

Primary practice location

1980 McCulloch Blvd N
Lake Havasu City, AZ 86403-0969

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 2

IdentifierTypeStateIssuer
126104MedicaidAZ
2157266OtherPK

Other names 1

  • Albertsons Pharmacy #3204 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160525000980 AZ DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Lake Havasu City, AZ

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 5

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.

Locations

1980 McCulloch Blvd N
Lake Havasu City, AZ 86403
Phone (928) 854-5311

NPI Registry JSON

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1346605185",
    "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": "1980 MCCULLOCH BLVD N",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864030969",
            "telephone_number": "928-854-8281",
            "fax_number": "928-453-3969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-21",
        "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": "Y006761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126104",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157266",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Albertsons Pharmacy #3204",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Albertsons Pharmacy #3204",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, 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.