Albertsons LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

15337 Issued in TX

Legal business name

ALBERTSONS LLC

Practice address

4625 Frankford Rd
Dallas, TX 75287-7108

Phone

(972) 732-6863

Fax

(972) 732-7564

NPI assigned

Jun 4, 2006

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

Enrollment Manager

Phone

(208) 395-3954

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• SAVON PHARMACY #4105 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 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.

Medicare medical equipment & supply locations

Member of 3

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

• Safeway Inc

  • Community/Retail Pharmacy
  • Sunnyside, WA
  • NPI 1861421885

  Member Of

  NPD member
• Star Markets Company Inc

  • Community/Retail Pharmacy
  • Marshfield, MA
  • NPI 1548216070

  Member Of

  NPD member
• United Supermarkets LLC

  • Community/Retail Pharmacy
  • Albuquerque, NM
  • NPI 1134166655

  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.

• John Byers

  • Pharmacist
  • Dallas, TX
  • NPI 1003297615
  NPD (past)
• Kavitha Gandikota

  • Pharmacist
  • Dallas, TX
  • NPI 1881068369
  NPD (past)

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586131200000",
    "number": "1922046341",
    "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": "4625 FRANKFORD RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752877108",
            "telephone_number": "972-732-6863",
            "fax_number": "972-732-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBERTSONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "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": "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": "TX",
            "license": "15337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463508",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2100803",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAVON PHARMACY #4105",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAVON PHARMACY #4105",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Albertsons LLC
• Albertsons LLC
• Albertsons LLC
• Albertsons LLC
• Albertsons LLC
• Albertsons LLC
• Albertsons LLC
• Jaclyn Lewis Albin, M.D.
• Vicki Albin
• Austin Albison, DC

• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.