Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Ontario, OR
NPI 1457096182 · NPPES record last updated May 30, 2022
Key facts
- NPI
- 1457096182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- ALBERTSONS LLC
- Practice address
- 1410 Westpark PLZ
Ontario, OR 97914-2000 - Phone
- (541) 889-9125
- Fax
- (541) 889-9126
- NPI assigned
- Apr 27, 2022
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 19
Member of 3
Practitioners 1
-
Alison Levanger, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2283343 | Albertsons Pharmacy #0131 | Certificate of waiver | Jun 5, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Albertsons Pharmacy #0131 |
Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Ostomy Supplies|Urological Supplies|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221012002426 | OR | DME Supplier - Pharmacy |
8729983515 | Practice locations: Ontario, OR |
National Provider Directory
- Tax ID family
- Albertsons 851
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1410 Westpark PLZ
Ontario, OR 97914-2000
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other names
- Albertsons Pharmacy #0131
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All providers in Ontario, OR · Community/Retail Pharmacy in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2022. 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.