Safeway Inc
Organization Active NPI Community/Retail Pharmacy · Cheney, WA
NPI 1508895533 · NPPES record last updated Apr 16, 2020
Key facts
- NPI
- 1508895533
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHAR.CF.60518763 (WA)
- Legal business name
- SAFEWAY INC
- Practice address
- 2710 1St St
Cheney, WA 99004-2032 - Phone
- (509) 235-6030
- Fax
- (509) 235-6386
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Member of 3
Practitioners 2
-
James R Duffy, RPH
-
Kathryn Grace Preble, RPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2061172 | Safeway Pharmacy #1740 | Certificate of waiver | Apr 4, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Safeway Pharmacy # 1740 |
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 (2 enrollments) in TX, WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040819001277 | TX | Part B Supplier - Centralized Flu Biller | 8628980299 |
This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
| O20100930012976 | WA | DME Supplier - Pharmacy |
8628980299 | Practice locations: Cheney, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHAR.CF.60518763 | WA | Yes |
Addresses
Primary practice location
2710 1St St
Cheney, WA 99004-2032
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Phone (208) 395-3963
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6023782 | Medicaid | WA | |
| 2110796 | Other | PK |
Other names
- SAFEWAY PHARMACY #1740
Other providers in Cheney, WA
- Lilibeth Rodriguez
- Shea N Romero
- Deborah Rowe
- Jessica Rutland
- Mariah Marie Saenz
- Sally Sanchez
- Cheree Nicole Sauer
- Leah Schumerth
- Cecelia Sears
- Micki Ann Sebold
All providers in Cheney, WA · Community/Retail Pharmacy in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 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.