NPIMap

Organization Active NPI

Albertsons LLC

  • Community/Retail Pharmacy
  • Horizon City, TX
National Provider Identifier
1841020146
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ALBERTSONS LLC
Practice address
13671 Eastlake Blvd
Horizon City, TX 79928
Phone
(915) 337-3190
Fax
(915) 337-3191
NPI assigned
Aug 2, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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 Primary

Addresses

Primary practice location

13671 Eastlake Blvd
Horizon City, TX 79928

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other names 1

  • Albertsons Pharmacy #0030 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250117001838 TX DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Horizon City, TX

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
45D2324040Albertsons Pharmacy #003013671 Eastlake Blvd, Horizon City, TX 79928Certificate of waiverMay 15, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Albertsons Pharmacy #003013671 Eastlake Blvd, Horizon City, TX 79928-7215(915) 337-3190 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Ostomy Supplies|Urological Supplies|Surgical Dressings Does not accept assignmentParticipating since Jan 1, 2001

National Provider Directory

National Provider Directory
Tax ID family
Albertsons 851386 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

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

View all 21

Member of 3

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

Locations

13671 Eastlake Blvd
Horizon City, TX 79928
Phone (915) 337-3190

NPI Registry JSON

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1841020146",
    "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": "13671 EASTLAKE BLVD",
            "city": "HORIZON CITY",
            "state": "TX",
            "postal_code": "79928",
            "telephone_number": "915-337-3190",
            "fax_number": "915-337-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Albertsons Pharmacy #0030",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Albertsons Pharmacy #0030",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Horizon City, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.