Active NPI
Carr-Gottstein Foods Co
- Community/Retail Pharmacy
- Ketchikan, AK
National Provider Identifier
1477582419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- CARR-GOTTSTEIN FOODS CO
- Practice address
- 2417 Tongass Ave
Ketchikan, AK 99901-5900 - Phone
- (907) 228-1960
- Fax
- (907) 228-1919
- NPI assigned
- Jul 2, 2006
- Organization subpart
- Yes
- Parent organization
- SAFEWAY INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 328 | AK | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
2417 Tongass Ave
Ketchikan, AK 99901-5900
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH0262 | Medicaid | AK | |
| 0202060 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- SAFEWAY PHARMACY #1818
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, AK
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040820000379 | TX | Part B Supplier - Centralized Flu Biller | 2860466489 |
18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
| O20100930002755 | AK | DME Supplier - Pharmacy | 2860466489 | Practice locations: Ketchikan, AK |
Other NPIs with the same Medicare PAC ID 15
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 16
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Safeway Pharmacy 1073
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
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": "1583280000000",
"number": "1477582419",
"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": "2417 TONGASS AVE",
"city": "KETCHIKAN",
"state": "AK",
"postal_code": "999015900",
"telephone_number": "907-228-1960",
"fax_number": "907-228-1919"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CARR-GOTTSTEIN FOODS CO",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SAFEWAY INC",
"enumeration_date": "2006-07-02",
"last_updated": "2020-03-04",
"certification_date": "2020-03-04",
"status": "A",
"authorized_official_last_name": "GIANNAKOPOULOS",
"authorized_official_first_name": "KATHY",
"authorized_official_title_or_position": "ENROLLMENTS MANAGER",
"authorized_official_telephone_number": "208-395-3954"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "AK",
"license": "328",
"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": "PH0262",
"state": "AK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "0202060",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SAFEWAY PHARMACY #1818",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ketchikan, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.