NPIMap

Organization Active NPI

Albertsons LLC

Doing business as Sav-on Pharmacy #0130

  • Community/Retail Pharmacy
  • Hailey, ID
National Provider Identifier
1730135245
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
21050RP Issued in ID
Legal business name
ALBERTSONS LLC
Doing business as
Sav-on Pharmacy #0130
Practice address
911 N Main St
Hailey, ID 83333
Phone
(208) 788-6713
Fax
(208) 788-6716
NPI assigned
May 26, 2006
Last updated
Apr 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 21050RP ID Primary

Addresses

Primary practice location

911 N Main St
Hailey, ID 83333

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 3

IdentifierTypeStateIssuer
2021863OtherPK
806287100MedicaidID
807496100MedicaidID

Other names 1

  • SAV-ON PHARMACY #0130 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130730000542 ID DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Hailey, ID

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D1035564Sav-on Pharmacy #0130911 Main St N, Hailey, ID 83333Certificate of waiverJan 4, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Sav-on Pharmacy #130911 N Main St, Hailey, ID 83333-8608(208) 788-6713 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings Does not accept assignmentParticipating since Jan 1, 2001

National Provider Directory

National Provider Directory
Tax ID family
Albertsons Inc 4103388 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Member of 7

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

Locations

3030 Cullerton St
Franklin Park, IL 60131
Phone (847) 916-4463

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1730135245",
    "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": "911 N MAIN ST",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "83333",
            "telephone_number": "208-788-6713",
            "fax_number": "208-788-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ID",
            "license": "21050RP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2021863",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806287100",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807496100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAV-ON PHARMACY #0130",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hailey, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.