Safeway Inc
Organization Active NPI Community/Retail Pharmacy · Fraser, CO
NPI 1508895566 · NPPES record last updated Apr 3, 2020
Key facts
- NPI
- 1508895566
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PDO.1620000001 (CO)
- Legal business name
- SAFEWAY INC
- Practice address
- 40 County Road 804
Fraser, CO 80442 - Phone
- (970) 726-6920
- Fax
- (970) 726-6836
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Member of 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, CO
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 |
| O20100930000434 | CO | DME Supplier - Pharmacy |
8628980299 | Practice locations: Fraser, CO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PDO.1620000001 | CO | Yes |
Addresses
Primary practice location
40 County Road 804
Fraser, CO 80442
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2003357 | Other | PK | |
| 45702845 | Medicaid | CO |
Other names
- SAFEWAY PHARMACY #1568
Other providers in Fraser, CO
- Caprice M. Olomon
- Orthopaedics of Steamboat Springs PC
- Mara Danielle Pacyga
- Joann Roberts
- Kristyn Roe
- Lauren Stokes
- Talk Therapy Corporation
- Joshua Vogt
- Emily Yarbrough
All providers in Fraser, CO · Community/Retail Pharmacy in Colorado
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.