Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Redlands, CA
NPI 1881640407 · NPPES record last updated Apr 3, 2020
Key facts
- NPI
- 1881640407
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY51299 (CA)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 450 E Cypress Ave
Redlands, CA 92373-6115 - Phone
- (909) 793-2218
- Fax
- (909) 792-5497
- NPI assigned
- May 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollment Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 21
Member of 7
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Sav-on Pharmacy #1319 |
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 in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130626000303 | CA | DME Supplier - Pharmacy |
8729983515 | Practice locations: Redlands, CA |
National Provider Directory
- Tax ID family
- Albertsons 851
Locations
450 E Cypress Ave
Redlands, CA 92373
Phone (909) 793-2218
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHY51299 | CA | Yes |
Addresses
Primary practice location
450 E Cypress Ave
Redlands, CA 92373-6115
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071PHA476830 | Medicaid | CA | |
| 071PHA389850 | Medicaid | CA | |
| 2065084 | Other | PK |
Other names
- SAVON PHARMACY #1319
Other providers in Redlands, CA
- Patricia Alaniz
- Sylvia Betty Alayza-Novoa
- Leilani Alba
- Brenda Albarran
- Albert J Chang, MD Inc
- Curtis Alexander Jr.
- Devin Alexander
- Watrina Michelle Alford
- Mia Alido
- Faezeh Alidousti Shahraki I
All providers in Redlands, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 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.