Safeway Inc
Organization Active NPI Community/Retail Pharmacy · Sunnyside, WA
NPI 1861421885 · NPPES record last updated May 20, 2020
Key facts
- NPI
- 1861421885
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHAR.CF.60516272 (WA)
- Legal business name
- SAFEWAY INC
- Practice address
- 613 S 6TH St
Sunnyside, WA 98944-2110 - Phone
- (509) 839-2103
- Fax
- (509) 837-6606
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Member of 3
Member organizations 1,291
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2014823 | Safeway Pharmacy #0563 | Certificate of waiver | Apr 4, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Safeway Pharmacy # 0563 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Surgical Dressings | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040819001277 | TX | Part B Supplier - Centralized Flu Biller | 8628980299 |
This NPI is an additional NPI on the enrollment Practice locations: Boise, ID |
| O20100930088696 | WA | DME Supplier - Pharmacy |
8628980299 | Practice locations: Sunnyside, WA |
National Provider Directory
Locations
613 S 6th St
Sunnyside, WA 98944
Phone (509) 839-2103
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHAR.CF.60516272 | WA | Yes |
Addresses
Primary practice location
613 S 6TH St
Sunnyside, WA 98944-2110
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6008627 | Medicaid | WA | |
| 2108808 | Other | PK |
Other names
- SAFEWAY PHARMACY #0563
Other providers in Sunnyside, WA
- Julietta Romero
- Ronald Couturier
- Hailey Marae Rowe
- Jose Sabalsa
- Anna Marisa Saenz
- Juanita Adriana Salas
- Adreeana Sandoval
- Marivel Sandoval
- Johnnie Saucedo
- School Dist #201
All providers in Sunnyside, WA · Community/Retail Pharmacy in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.