NPIMap

Organization Active NPI

Safeway Inc

Doing business as Safeway Pharmacy #1135

  • Pharmacy
  • Cle Elum, WA
National Provider Identifier
1942744149
Registry record updated Oct 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHAR.CF.60720388 Issued in WA
Legal business name
SAFEWAY INC
Doing business as
Safeway Pharmacy #1135
Practice address
804 W 1St St
Cle Elum, WA 98922-1012
Phone
(509) 852-3006
Fax
(509) 852-3010
NPI assigned
Dec 7, 2016
Last updated
Oct 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2018

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

Authorized official

Name
Tiffany Eliopulos
Title
Assistant Manager, Enrollments
Phone
(208) 395-3906

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X PHAR.CF.60720388 WA Primary

Addresses

Primary practice location

804 W 1St St
Cle Elum, WA 98922-1012

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers 2

IdentifierTypeStateIssuer
2073901MedicaidWA
2166698OtherPK

Other names 1

  • Safeway Pharmacy #1135 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170307001846 WA DME Supplier - PharmacyDME Supplier - Grocery Store 8628980299 Practice locations: Cle Elum, WA

National Provider Directory

National Provider Directory
Tax ID family
Safeway Pharmacy 123470 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

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

View all 13

Member of 3

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": "1481068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540166400000",
    "number": "1942744149",
    "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": "804 W 1ST ST",
            "city": "CLE ELUM",
            "state": "WA",
            "postal_code": "989221012",
            "telephone_number": "509-852-3006",
            "fax_number": "509-852-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-07",
        "last_updated": "2018-10-22",
        "status": "A",
        "authorized_official_last_name": "ELIOPULOS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ASSISTANT MANAGER, ENROLLMENTS",
        "authorized_official_telephone_number": "208-395-3906"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60720388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2073901",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166698",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Safeway Pharmacy #1135",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Safeway Pharmacy #1135",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cle Elum, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.