Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Pocatello, ID
NPI 1669428173 · NPPES record last updated Apr 2, 2020
Key facts
- NPI
- 1669428173
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 21053RP (ID)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 330 E Benton St
Pocatello, ID 83201 - Phone
- (208) 233-0651
- Fax
- (208) 478-1731
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollment Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 24
Member of 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130812000668 | ID | DME Supplier - Pharmacy |
8729983515 | Practice locations: Pocatello, ID |
National Provider Directory
- Tax ID family
- Albertsons 851
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 21053RP | ID | Yes |
Addresses
Primary practice location
330 E Benton St
Pocatello, ID 83201
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807495400 | Medicaid | ID | |
| 2020588 | Other | PK | |
| 002256400 | Medicaid | ID |
Other names
- SAV-ON PHARMACY #0159
Other providers in Pocatello, ID
- Shawn Akina
- Ala, LLC
- Ala, LLC
- Ala, LLC
- Alameda Vision Inc.
- Kobi Alcocer
- Cynthia Marie Aldana
- Shelby Leigh Alder
- Clarissa Alexander
- Kathleen Alexander
All providers in Pocatello, ID · Community/Retail Pharmacy in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.