Safeway Inc
Organization Active NPI Community/Retail Pharmacy · Trinidad, CO
NPI 1912936972 · NPPES record last updated Apr 15, 2020
Key facts
- NPI
- 1912936972
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PDO.1200000006 (CO)
- Legal business name
- SAFEWAY INC
- Practice address
- 457 W Main St
Trinidad, CO 81082-2623 - Phone
- (719) 846-3086
- Fax
- (719) 846-4087
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollments Manager
- Phone
- (208) 395-3954
Member of 3
Practitioners 5
-
Kathy M McCarthy, RPH
-
Jameson Moon Pickerill, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2075290 | Safeway Pharmacy #0722 | Certificate of waiver | Nov 3, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Safeway Pharmacy #0722 |
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, CO
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 |
| O20100930025232 | CO | DME Supplier - Pharmacy |
8628980299 | Practice locations: Trinidad, CO |
National Provider Directory
Locations
457 W Main St
Trinidad, CO 81082
Phone (719) 846-2246
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PDO.1200000006 | CO | Yes |
Addresses
Primary practice location
457 W Main St
Trinidad, CO 81082-2623
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Phone (208) 395-6200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03001583 | Medicaid | CO | |
| 2002092 | Other | PK |
Other names
- SAFEWAY PHARMACY #0722
Other providers in Trinidad, CO
- Raza Uddin OD LLC
- David R. Reitter
- Reliant Renal Care-Colorado, LLC
- Rocky Mountain Eye Center, Inc. a Colorado Provider Network
- William Mervin Rowland Jr.
- Sally L. Fabec, M. D.
- Salud Family Health
- Salud Family Health
- San Luis Valley Eye Care LLC
- Dario Byung San Roman
All providers in Trinidad, CO · Community/Retail Pharmacy in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 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.