NPIMap

Albertsons LLC

Organization Active NPI Community/Retail Pharmacy · Ft Worth, TX

NPI 1477590800 · NPPES record last updated Jun 17, 2025

Key facts

NPI
1477590800
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
12540 (TX)
Legal business name
ALBERTSONS LLC
Practice address
3525 Sycamore School Rd
Ft Worth, TX 76133-7805
Phone
(817) 346-4457
Fax
(817) 294-4792
NPI assigned
Jun 2, 2006
Organization subpart
No

Authorized official

Name
Kathy Giannakopoulos
Title
Enrollment Manager
Phone
(208) 395-3954

Member of 3

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

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1032740Albertsons Pharmacy #4277
3525 Sycamore School Road, Fort Worth, TX 76133		Certificate of waiverDec 7, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Albertsons Pharmacy #4277
3525 Sycamore School Rd, Fort Worth, TX 76133-7805 · (817) 346-4457		 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
Participating since Jan 1, 2001

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20041014000405 TX Part B Supplier - Centralized Flu Biller 8729983515 This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID
O20100930089748 TX DME Supplier - Pharmacy
DME Supplier - Grocery Store		 8729983515 Practice locations: Fort Worth, TX

National Provider Directory

Locations

3525 Sycamore School Rd
Ft Worth, TX 76133
Phone (817) 346-4457

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 12540 TX Yes

Addresses

Primary practice location

3525 Sycamore School Rd
Ft Worth, TX 76133-7805

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers

IdentifierTypeStateIssuer
2097184OtherPK
462920MedicaidTX

Other names

  • Albertsons Pharmacy #4277 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 17, 2025.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1477590800",
    "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": "3525 SYCAMORE SCHOOL RD",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761337805",
            "telephone_number": "817-346-4457",
            "fax_number": "817-294-4792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "12540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2097184",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "462920",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Albertsons Pharmacy #4277",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ft Worth, TX

All providers in Ft Worth, TX · Community/Retail Pharmacy in Texas

Sources for this page

Verify at the official NPI Registry.