Albertsons LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ALBERTSONS LLC

Practice address

250 S Eagle Rd
Eagle, ID 83616-5906

Phone

(208) 939-9850

Fax

(208) 939-2721

NPI assigned

Mar 9, 2017

Organization subpart

Yes

Parent organization

ALBERTSONS COMPANIES LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Demond Hawkins

Title

MGR, Host Admin & Enrollments

Phone

(208) 395-3905

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• SAV-ON PHARMACY Doing business as

Part of

Albertsons Companies LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493683200000",
    "number": "1508307653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "address_2": "MAILSTOP SEC2-B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940",
            "telephone_number": "208-395-3963",
            "fax_number": "623-336-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S EAGLE RD",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165906",
            "telephone_number": "208-939-9850",
            "fax_number": "208-939-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALBERTSONS COMPANIES LLC",
        "enumeration_date": "2017-03-09",
        "last_updated": "2017-05-02",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "DEMOND",
        "authorized_official_title_or_position": "MGR, HOST ADMIN & ENROLLMENTS",
        "authorized_official_telephone_number": "208-395-3905"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNT BILLER",
            "identifier": "APPLIED FOR",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAV-ON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Eagle, ID
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.