Safeway Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY52378 Issued in CA

Legal business name

SAFEWAY INC

Doing business as

Safeway Pharmacy #1592

Practice address

7815 N Lake Blvd
Kings Beach, CA 96143

Phone

(530) 546-0186

Fax

(530) 546-0277

NPI assigned

Aug 11, 2006

Last updated

Apr 21, 2020By the provider in NPPES

Organization subpart

No

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 3

Addresses

Other identifiers 2

Other names 1

• SAFEWAY PHARMACY #1592 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX, CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Member of 3

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

• Vons Companies Inc

  dba Vons Pharmacy #2200

  • Community/Retail Pharmacy
  • Monrovia, CA
  • NPI 1376589986

  Member Of

  NPD member
• Genuardi's Family Markets LP GFM

  dba Genuardi's Pharmacy #1005

  • Community/Retail Pharmacy
  • Maple Glen, PA
  • NPI 1801034640

  Member Of

  NPD member
• Randalls Food & Drugs LP

  dba Randalls Pharmacy #1896

  • Community/Retail Pharmacy
  • Cedar Park, TX
  • NPI 1356387971

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nyla Davis, R.PH.

  • Pharmacist
  • Kings Beach, CA
  • NPI 1265733497
  NPD (past)
• Raymond Richard Wasson, R.PH.

  • Pharmacist
  • Kings Beach, CA
  • NPI 1609177872
  NPD (past)

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1912918053",
    "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",
            "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": "7815 N LAKE BLVD",
            "city": "KINGS BEACH",
            "state": "CA",
            "postal_code": "96143",
            "telephone_number": "530-546-0186",
            "fax_number": "530-546-0277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY52378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912918053",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1992420",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #1592",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Joseph Pangallo, SUDRC
• Anna Leigh Patterson
• Placer County Community Clinic
• Barbara Ricotta
• Kellee Rutley, D.C.
• Gregory Lee Smith, R.PH,DC
• Susan Smith
• Susanne Scott Swallow, LM, CPM
• Cathy Joan Taylor, D.C.
• Sherry Thompson

• Community/Retail Pharmacy in Kings Beach, CA
• Providers in Kings Beach, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.