Active NPI
Safeway Inc
- Community/Retail Pharmacy
- Flagstaff, AZ
National Provider Identifier
1629007679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- Y006150
- Legal business name
- SAFEWAY INC
- Practice address
- 1201 S Plaza Way
Flagstaff, AZ 86001-6318 - Phone
- (928) 556-9170
- Fax
- (928) 556-9869
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
NPPES NPI Registry
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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Y006150 | AZ | Primary |
Addresses
Primary practice location
1201 S Plaza Way
Flagstaff, AZ 86001-6318
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Phone (208) 395-6200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119744 | Medicaid | AZ | |
| 1989475 | Other | PK |
Other names 1
- SAFEWAY PHARMACY #2028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, AZ
Enrollment records 2
| 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 |
| O20100930025321 | AZ | DME Supplier - Pharmacy | 8628980299 | Practice locations: Flagstaff, AZ |
National Provider Directory
National Provider DirectoryMember of 3
Organizations this organization is a member of, according to the National Provider Directory.
-
- Community/Retail Pharmacy
- King of Prussia, PA
- NPI 1265659361
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151798400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1586304000000",
"number": "1629007679",
"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": "208-395-6200",
"fax_number": "623-336-6896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 S PLAZA WAY",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860016318",
"telephone_number": "928-556-9170",
"fax_number": "928-556-9869"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAFEWAY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-02",
"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": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "AZ",
"license": "Y006150",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119744",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "1989475",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SAFEWAY PHARMACY #2028",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "SAFEWAY PHARMACY #2028",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Flagstaff, AZ
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.