Safeway Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SAFEWAY INC

Doing business as

Safeway Pharmacy #2909

Practice address

707 E South Boulder Rd
Louisville, CO 80027-1327

Phone

(303) 665-2025

Fax

(303) 665-2829

NPI assigned

Jun 21, 2006

Last updated

Jan 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Ann Rivers, CPHT

Title

Managed Care Plan Speciaist

Phone

(623) 869-3524

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• SAFEWAY PHARMACY #2909 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232323200000",
    "number": "1528004132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20427 N 27TH AVE # MSC4551",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850273241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E SOUTH BOULDER RD",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800271327",
            "telephone_number": "303-665-2025",
            "fax_number": "303-665-2829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2009-01-19",
        "status": "A",
        "authorized_official_last_name": "RIVERS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MANAGED CARE PLAN SPECIAIST",
        "authorized_official_telephone_number": "623-869-3524",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CO",
            "license": "0812",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0608870",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03765351",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #2909",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elaine Stephanie Rusin, M.D.
• Russell Hanson, D.D.S., P.C.
• Kristin Schudy Russell, PH.D.
• Gregory D. Ruth, M.D.
• Daniel Ryan, FNP-C
• Randall Scott Sagante, MSMHC
• Sam's Club Optical (Sam's Club Optical 30-6229)
• Kelly Lynn Sammis, PT
• Jesus Sanchez, PH.D.
• Cassidy J. Sanders, PA

• Community/Retail Pharmacy in Louisville, CO
• Providers in Louisville, CO by specialty
• Community/Retail Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.