Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Mountlake Terrace, WA
NPI 1396791802 · NPPES record last updated Apr 3, 2020
Key facts
- NPI
- 1396791802
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHAR.CF.60342811 (WA)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 4301 212TH St SW
Mountlake Terrace, WA 98043 - Phone
- (425) 775-5011
- Fax
- (425) 775-3949
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollment Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 23
Member of 7
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D1033044 | Safeway Pharmacy #0414 | Certificate of waiver | Apr 4, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Safeway Pharmacy #0414 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130605000347 | WA | DME Supplier - Pharmacy |
8729983515 | Practice locations: Mountlake Terrace, WA |
National Provider Directory
- Tax ID family
- Albertsons 851
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHAR.CF.60342811 | WA | Yes |
Addresses
Primary practice location
4301 212TH St SW
Mountlake Terrace, WA 98043
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2110447 | Other | PK | |
| 6020770 | Medicaid | WA |
Other names
- Safeway Pharmacy #0414
Other providers in Mountlake Terrace, WA
- Diane Lynn Agnew
- Nelly Aguilar-Santos
- Anjoli M Aisenbrey
- Andra Arlene Aitken
- Chika Okem Akwiwu
- Frank Turner Aldridge
- Meskerem Alemu
- Natalie Sierra Allen
- Altra Health Care PLLC
- Robert Alvarado
All providers in Mountlake Terrace, WA · Community/Retail Pharmacy in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.