NPIMap

Organization Active NPI

Safeway Inc

  • Community/Retail Pharmacy
  • Prescott, AZ
National Provider Identifier
1811926884
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y006107 Issued in AZ
Legal business name
SAFEWAY INC
Doing business as
Safeway Pharmacy #0245
Practice address
1044 Willow Creek Rd
Prescott, AZ 86301
Phone
(928) 443-0300
Fax
(928) 443-0500
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Y006107 AZ Primary

Addresses

Primary practice location

1044 Willow Creek Rd
Prescott, AZ 86301

Mailing address

250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83712-3940
Phone (208) 395-6200

Other identifiers 2

IdentifierTypeStateIssuer
1990431OtherPK
479544MedicaidAZ

Other names 1

  • Safeway Pharmacy #0245 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
O20100930063242 AZ DME Supplier - PharmacyDME Supplier - Grocery Store 8628980299 Practice locations: Prescott, 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": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1811926884",
    "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": "1044 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86301",
            "telephone_number": "928-443-0300",
            "fax_number": "928-443-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y006107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1990431",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "479544",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Safeway Pharmacy #0245",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.