Albertsons LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2660 Issued in LA

Legal business name

ALBERTSONS LLC

Practice address

4060 Ryan St
Lake Charles, LA 70605-2841

Phone

(337) 478-9197

Fax

(337) 480-0070

NPI assigned

Jun 1, 2006

Organization subpart

No

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

Authorized official

Name

Kathy Giannakopoulos

Title

Enrollment Manager

Phone

(208) 395-3954

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• ALBERTSONS PHARMACY #0717 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX, LA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Member of 3

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

• Safeway Inc

  • Community/Retail Pharmacy
  • Sunnyside, WA
  • NPI 1861421885

  Member Of

  NPD member
• Star Markets Company Inc

  • Community/Retail Pharmacy
  • Marshfield, MA
  • NPI 1548216070

  Member Of

  NPD member
• United Supermarkets LLC

  • Community/Retail Pharmacy
  • Albuquerque, NM
  • NPI 1134166655

  Member Of

  NPD member

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Allison M Bartek

  • Pharmacist
  • Lake Charles, LA
  • NPI 1134894868
  NPD (past)
• Thomas Bel

  • Pharmacist
  • Lake Charles, LA
  • NPI 1194600742
  NPD (past)
• Agnes F Briles, PHARM D

  • Pharmacist
  • Lake Charles, LA
  • NPI 1689935678
  NPD (past)
• Katarina Caraway

  • Pharmacist
  • Westlake, LA
  • NPI 1174053581
  NPD (past)
• Ebony Cook

  • Pharmacist
  • Lake Charles, LA
  • NPI 1609159029
  NPD (past)
• Kayla Sherer Hatten

  • Pharmacist
  • Lake Charles, LA
  • NPI 1265150304
  NPD (past)
• Daphne Letlow, PHARMD

  • Pharmacist
  • Lake Charles, LA
  • NPI 1568722627
  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1598702011",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 RYAN ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706052841",
            "telephone_number": "337-478-9197",
            "fax_number": "337-480-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ENROLLMENT 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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "2660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2032875",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1260878",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALBERTSONS PHARMACY #0717",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wanda S Aguillard, NA
• Aim Systems
• Bolarinwa Akanbi, MD
• Alan C Perry DDS (a Professional Dental Corporation)
• Alawrass LLC
• Albertsons LLC
• Kristine Alcantara, BCABA
• Trimone Fondel Alex, RN
• Cynthia Alexander
• Dorothy Mae Alexander, LCSW

• All providers in Lake Charles, LA
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.