Safeway Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY52317 Issued in CA

Legal business name

SAFEWAY INC

Practice address

110 Strawberry Village Blvd
BLDG 100
Mill Valley, CA 94941

Phone

(415) 360-9020

Fax

(415) 360-9021

NPI assigned

Jun 24, 2006

Organization subpart

No

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

Authorized official

Name

Tiffany Eliopulos

Title

Assistant Manager, Enrollments

Phone

(208) 395-3906

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• SAFEWAY PHARMACY #2718 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX, CA2 enrollments

Enrollment records 2

Member of 3

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

• Vons Companies Inc

  • Community/Retail Pharmacy
  • Rancho Santa Margarita, CA
  • NPI 1659300689

  Member Of

  NPD member
• Genuardi'S Family Markets LP (GFM)

  • Community/Retail Pharmacy
  • King of Prussia, PA
  • NPI 1265659361

  Member Of

  NPD member
• Randalls Food & Drugs LP

  • Community/Retail Pharmacy
  • Georgetown, TX
  • NPI 1912419649

  Member Of

  NPD member

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1790711570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "address_2": "MAILSTOP SEC2-B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837123940",
            "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": "110 STRAWBERRY VILLAGE BLVD",
            "address_2": "BLDG 100",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-360-9020",
            "fax_number": "415-360-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2018-10-04",
        "status": "A",
        "authorized_official_last_name": "ELIOPULOS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ASSISTANT MANAGER, ENROLLMENTS",
        "authorized_official_telephone_number": "208-395-3906"
    },
    "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": "CA",
            "license": "PHY52317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790711570",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1994154",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #2718",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter Lewis Rutter, MD
• Caroline Rybicki, DPT, PT
• Michael Martin Saal, M. D.
• Deirdre Elizabeth Sabow, AMFT
• Safeway Inc
• Diane Louise Salas Monteil, LAC
• Timothy F Salz, PH.D.
• Toby Otis Salz, M.D.
• Anika L Sanda, M.D.
• Sarabenet Sequeira, MD, PC

• Community/Retail Pharmacy in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.