NPIMap

Organization Active NPI

Safeway Inc

Doing business as Safeway Pharmacy #2811

  • Community/Retail Pharmacy
  • Colorado Springs, CO
National Provider Identifier
1619913225
Registry record updated Dec 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SAFEWAY INC
Doing business as
Safeway Pharmacy #2811
Practice address
3335 N Academy Blvd
Colorado Springs, CO 80917-5103
Phone
(719) 574-1560
Fax
(719) 574-3540
NPI assigned
Jun 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2008

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 Specialist
Phone
(623) 869-3524

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 02459 CO
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

3335 N Academy Blvd
Colorado Springs, CO 80917-5103

Mailing address

20427 N 27TH Ave # Msc4551
Phoenix, AZ 85027-3241

Other identifiers 4

IdentifierTypeStateIssuer
03765328MedicaidCO
0606369OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PHC015OtherCOFLU #
P00229889OtherCORR #

Other names 1

  • SAFEWAY PHARMACY #2811 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819001277 TX Part B Supplier - Centralized Flu Biller 8628980299 This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Member of 3

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

Locations

3335 N Academy Blvd
Colorado Springs, CO 80917
Phone (719) 574-1560

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229299200000",
    "number": "1619913225",
    "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": "3335 N ACADEMY BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175103",
            "telephone_number": "719-574-1560",
            "fax_number": "719-574-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2008-12-15",
        "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 SPECIALIST",
        "authorized_official_telephone_number": "623-869-3524",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CO",
            "license": "02459",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03765328",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0606369",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLU #",
            "identifier": "PHC015",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR #",
            "identifier": "P00229889",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #2811",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2008; 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.