Jewel Osco Southwest LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

JEWEL OSCO SOUTHWEST LLC

Practice address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Phone

(208) 395-3963

Fax

(623) 336-6363

NPI assigned

Sep 27, 2006

Organization subpart

Yes

Parent organization

ALBERTSONS HOLDINGS LLCAs reported in NPPES

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

Authorized official

Name

Mr. Lorenzo Torres III

Title

Pharmacy Enrollment Specialist

Phone

(208) 395-3963

Specialties & licenses 3

Addresses

Other identifiers 1

Member of 1

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

• Haggen Opco North LLC

  • Community/Retail Pharmacy
  • Grants Pass, OR
  • NPI 1063468064

  Member Of

  NPD member

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1629169289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 REMITTANCE DRIVE",
            "address_2": "SUITE 1242",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606751242",
            "telephone_number": "847-916-4463",
            "fax_number": "847-916-4736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940",
            "telephone_number": "208-395-3963",
            "fax_number": "623-336-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWEL OSCO SOUTHWEST LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALBERTSONS HOLDINGS LLC",
        "enumeration_date": "2006-09-27",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TORRES",
        "authorized_official_first_name": "LORENZO",
        "authorized_official_title_or_position": "PHARMACY ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "208-395-3963",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE TPAN",
            "identifier": "P00447103",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate Jacqueline Jesenko, LMSW
• Jesse Tangen LCSW Counseling PLLC
• Rachel Jessen, LCSW
• Jessica Maitri, LCSW PLLC Dba Yothera LLC
• Alice Rachel Jessup
• Calvin Thomas Jewell, MD
• Charles Michael Jewell, LPC
• Madeleine Jewell, MCOUN, LPC, NCC
• Marcia Jewell, RN
• JF Bcba Services

• Community/Retail Pharmacy in Boise, ID
• Providers in Boise, ID by specialty
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.