NPIMap

Organization Active NPI

Albertsons LLC

Doing business as Osco Pharmacy #0067

  • Community/Retail Pharmacy
  • Gillette, WY
National Provider Identifier
1770767279
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
R10149 Issued in WY
Legal business name
ALBERTSONS LLC
Doing business as
Osco Pharmacy #0067
Practice address
2610 S Douglas Hwy
Gillette, WY 82718-6468
Phone
(307) 687-2996
Fax
(307) 686-6153
NPI assigned
Dec 20, 2007
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X R10149 WY Primary

Addresses

Primary practice location

2610 S Douglas Hwy
Gillette, WY 82718-6468

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 2

IdentifierTypeStateIssuer
125403100MedicaidWY
2111694OtherPK

Other names 1

  • OSCO PHARMACY #0067 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130806000626 WY DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Gillette, WY

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 15

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

View all 15

Member of 7

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": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1770767279",
    "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": "2610 S DOUGLAS HWY",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827186468",
            "telephone_number": "307-687-2996",
            "fax_number": "307-686-6153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WY",
            "license": "R10149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125403100",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2111694",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSCO PHARMACY #0067",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OSCO PHARMACY #0067",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gillette, WY

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.