NPIMap

Organization Active NPI

Safeway Inc

  • Community/Retail Pharmacy
  • Sacramento, CA
National Provider Identifier
1467928200
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SAFEWAY INC
Practice address
3680 Crocker Dr
Ste 100
Sacramento, CA 95818
Phone
(279) 399-9270
Fax
(279) 399-9262
NPI assigned
Oct 19, 2018
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Member of 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2289179Safeway Pharmacy # 30133680 Crocker Drive Suite 100, Sacramento, CA 95818Certificate of waiverSep 5, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Safeway Pharmacy #30133680 Crocker Dr, Sacramento, CA 95818-2949(279) 399-9270 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings Does not accept assignmentParticipating since Jan 1, 2017

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20190322000926 CA DME Supplier - PharmacyDME Supplier - Grocery Store 8628980299 Practice locations: Sacramento, CA

National Provider Directory

National Provider Directory
Tax ID family
Safeway Pharmacy 1073 (70 organizations share this tax ID)

Locations

3680 Crocker Dr
Ste 100
Sacramento, CA 95818
Phone (279) 399-9270

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

NPPES NPI Registry

Primary practice location

3680 Crocker Dr
Ste 100
Sacramento, CA 95818

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
PENDINGMedicaidCA

Other names 1

NPPES NPI Registry
  • SAFEWAY PHARMACY #3013 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 13, 2019.

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1467928200",
    "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": "3680 CROCKER DR",
            "address_2": "STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95818",
            "telephone_number": "279-399-9270",
            "fax_number": "279-399-9262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-19",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "MANAGER ENROLLMENTS",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #3013",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAFEWAY PHARMACY #3013",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.