Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Benbrook, TX
NPI 1477591899 · NPPES record last updated Dec 3, 2010
Key facts
- NPI
- 1477591899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 17513 (TX)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 8510 Highway 377 S
Benbrook, TX 76126-2545 - Phone
- (817) 249-6668
- Fax
- (817) 249-4963
- NPI assigned
- Jun 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Dan Johnson
- Title
- Manager Managed Healthcare
- Phone
- (208) 395-3436
Member of 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041014000405 | TX | Part B Supplier - Centralized Flu Biller | 8729983515 |
This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 17513 | TX | Yes |
Addresses
Primary practice location
8510 Highway 377 S
Benbrook, TX 76126-2545
Mailing address
3030 Cullerton St
Franklin Park, IL 60131-2205
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 464031 | Medicaid | TX | |
| 4599556 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names
- SAVON PHARMACY
Other providers in Benbrook, TX
- Timothy Adams
- Gabrielle Elisabeth Adamson
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- Austin Slate Admire
- Ads Psychological Services, PLLC
- All in the Family Support Services
- Anne Allen
- Miyia Rachelle Alston
- Janie Amaya
- Jasmine Amezcua
All providers in Benbrook, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2010. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.