Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Lake Oswego, OR
NPI 1487009296 · NPPES record last updated Apr 3, 2020
Key facts
- NPI
- 1487009296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- RP-0002079-CS (OR)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 16199 Boones Ferry Rd
Lake Oswego, OR 97035-4201 - Phone
- (503) 635-0914
- Fax
- (503) 635-6633
- NPI assigned
- Apr 29, 2016
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollment Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 20
Member of 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D1080682 | Sav-on Pharmacy #3531 | Certificate of waiver | Dec 21, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Sav-on Pharmacy #3531 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160803002352 | OR | DME Supplier - Pharmacy |
8729983515 | Practice locations: Lake Oswego, 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 | RP-0002079-CS | OR | Yes |
Addresses
Primary practice location
16199 Boones Ferry Rd
Lake Oswego, OR 97035-4201
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487009296 | Medicaid | OR | |
| 2159944 | Other | PK |
Other names
- Sav-On Pharmacy #3531
Other providers in Lake Oswego, OR
- Brook Ahnemann
- Alexis Storms Aiger
- Diane Margaret Akasaka
- Joanna Albergo
- Lisa Albers
- Albertsons LLC
- Callie Albertus
- Kelly Christine Aldinger
- Melissa Noelle Alexander
- Katherina I Alexandre
All providers in Lake Oswego, 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 Apr 3, 2020. 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.