NPIMap

Organization Active NPI

Safeway Inc

Doing business as Safeway Pharmacy #1139

  • Community/Retail Pharmacy
  • Douglas, AZ
National Provider Identifier
1356370308
Registry record updated Dec 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SAFEWAY INC
Doing business as
Safeway Pharmacy #1139
Practice address
90 Fifth St
Douglas, AZ 85607
Phone
(520) 364-7568
Fax
(520) 364-9053
NPI assigned
Jul 2, 2006
Last updated
Dec 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2008

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

Authorized official

Name
Michelle Ann Rivers, CPHT
Title
Managed Care Plan Specialist
Phone
(623) 869-3524

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X P02518 AZ
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

90 Fifth St
Douglas, AZ 85607

Mailing address

20427 N 27TH Ave # Msc4551
Phoenix, AZ 85027-3241

Other identifiers 3

IdentifierTypeStateIssuer
147050MedicaidAZ
0320135OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0016820210004MedicaidAZ

Other names 1

  • SAFEWAY PHARMACY #1139 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819001277 TX Part B Supplier - Centralized Flu Biller 8628980299 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

90 W 5th St
Douglas, AZ 85607
Phone (520) 364-7568

Practitioners & affiliated clinicians

Practitioners 3

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": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228089600000",
    "number": "1356370308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20427 N 27TH AVE # MSC4551",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 FIFTH ST",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "85607",
            "telephone_number": "520-364-7568",
            "fax_number": "520-364-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2008-12-01",
        "status": "A",
        "authorized_official_last_name": "RIVERS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MANAGED CARE PLAN SPECIALIST",
        "authorized_official_telephone_number": "623-869-3524",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AZ",
            "license": "P02518",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147050",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0320135",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016820210004",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #1139",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglas, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; 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.