NPIMap

Organization Active NPI

Safeway Inc

Doing business as Safeway Pharmacy #2799

  • Community/Retail Pharmacy
  • Peoria, AZ
National Provider Identifier
1730369653
Registry record updated Apr 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y006165 Issued in AZ
Legal business name
SAFEWAY INC
Doing business as
Safeway Pharmacy #2799
Practice address
28455 N Vistancia Blvd
Peoria, AZ 85383-2087
Phone
(623) 271-7617
Fax
(623) 271-7728
NPI assigned
Nov 8, 2007
Last updated
Apr 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2020

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Y006165 AZ Primary

Addresses

Primary practice location

28455 N Vistancia Blvd
Peoria, AZ 85383-2087

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940
Phone (208) 395-6200

Other identifiers 2

IdentifierTypeStateIssuer
344256MedicaidAZ
1992598OtherPK

Other names 1

  • SAFEWAY PHARMACY #2799 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments

Enrollment records 2

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
O20100930035995 AZ DME Supplier - PharmacyDME Supplier - Grocery Store 8628980299 Practice locations: Peoria, AZ

National Provider Directory

National Provider Directory

Member of 3

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

NPI Registry JSON

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586217600000",
    "number": "1730369653",
    "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": "28455 N VISTANCIA BLVD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853832087",
            "telephone_number": "623-271-7617",
            "fax_number": "623-271-7728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "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": "Y006165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344256",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1992598",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #2799",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAFEWAY PHARMACY #2799",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.

Verify at the official NPI Registry.