NPIMap

Organization Active NPI

Albertsons LLC

Doing business as Osco Pharmacy #0024

  • Community/Retail Pharmacy
  • Missoula, MT
National Provider Identifier
1891057634
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHA-PHR-LIC-14920 Issued in MT
Legal business name
ALBERTSONS LLC
Doing business as
Osco Pharmacy #0024
Practice address
1003 E Broadway St
Missoula, MT 59802-4971
Phone
(406) 549-6163
Fax
(406) 549-1786
NPI assigned
Jun 7, 2012
Last updated
Nov 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Authorized official

Name
Kathy Giannakopoulos
Title
Enrollment Manager
Phone
(208) 395-3954

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Home Modifications Contractor 171WH0202X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHA-PHR-LIC-14920 MT Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

1003 E Broadway St
Missoula, MT 59802-4971

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 2

IdentifierTypeStateIssuer
1891057634MedicaidMT
2135818OtherPK

Other names 1

  • OSCO PHARMACY #0024 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130715000341 MT DME Supplier - PharmacyDME Supplier - Grocery Store 8729983515 Practice locations: Missoula, MT

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
27D0937738Osco Pharmacy #00241003 East Broadway St, Missoula, MT 59802Certificate of waiverDec 21, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Osco Pharmacy #00241003 E Broadway St, Missoula, MT 59802-4971(406) 549-6163 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 assignmentParticipating since Jan 1, 2001

National Provider Directory

National Provider Directory
Tax ID family
Albertsons Inc 4103388 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

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

View all 14

Member of 7

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": "1339027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1891057634",
    "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": "1003 E BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024971",
            "telephone_number": "406-549-6163",
            "fax_number": "406-549-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-07",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "208-395-3954"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "",
            "desc": "Contractor, Home Modifications",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MT",
            "license": "PHA-PHR-LIC-14920",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891057634",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135818",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSCO PHARMACY #0024",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; 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.