NPIMap

Organization Active NPI

Safeway Inc

Doing business as Haggen Pharmacy #3604

  • Community/Retail Pharmacy
  • Marysville, WA
National Provider Identifier
1558716985
Registry record updated Apr 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHAR.CF.60657875 Issued in WA
Legal business name
SAFEWAY INC
Doing business as
Haggen Pharmacy #3604
Practice address
3711 88TH St NE
Marysville, WA 98270-7214
Phone
(360) 530-7761
Fax
(360) 530-7795
NPI assigned
May 4, 2016
Last updated
Apr 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2020

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

Authorized official

Name
Kathy Giannakopoulos
Title
Enrollments Manager
Phone
(208) 395-3954

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X PHAR.CF.60657875 WA Primary

Addresses

Primary practice location

3711 88TH St NE
Marysville, WA 98270-7214

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940
Phone (208) 395-3906

Other names 1

  • Haggen Pharmacy #3604 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161003002667 WA DME Supplier - PharmacyDME Supplier - Grocery Store 8628980299 Practice locations: Marysville, WA

National Provider Directory

National Provider Directory
Tax ID family
Safeway Pharmacy 159070 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3711 88th St NE
Marysville, WA 98270
Phone (360) 530-7761

NPI Registry JSON

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586304000000",
    "number": "1558716985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940",
            "telephone_number": "208-395-3906",
            "fax_number": "623-336-6896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3711 88TH ST NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982707214",
            "telephone_number": "360-530-7761",
            "fax_number": "360-530-7795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ENROLLMENTS MANAGER",
        "authorized_official_telephone_number": "208-395-3954"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60657875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haggen Pharmacy #3604",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Haggen Pharmacy #3604",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marysville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2020; 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.