NPIMap

Organization Active NPI

Safeway Inc

  • Community/Retail Pharmacy
  • Mesa, AZ
National Provider Identifier
1962431932
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
Y006162 Issued in AZ
Legal business name
SAFEWAY INC
Practice address
9101 E Baseline Rd
Mesa, AZ 85209-7758
Phone
(480) 281-0180
Fax
(480) 281-0165
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 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
Community/Retail Pharmacy 3336C0003X Y006162 AZ Primary

Addresses

Primary practice location

9101 E Baseline Rd
Mesa, AZ 85209-7758

Mailing address

250 E Parkcenter Blvd
Mailstop Sec2-B
Boise, ID 83712-3940
Phone (208) 395-6200

Other identifiers 2

IdentifierTypeStateIssuer
1991735OtherPK
847890MedicaidAZ

Other names 1

  • SAFEWAY PHARMACY #2676 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819001277 TX Part B Supplier - Centralized Flu Biller 8628980299 This NPI is an additional NPI on the enrollment
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Member of 3

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1962431932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "address_2": "MAILSTOP SEC2-B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837123940",
            "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": "9101 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852097758",
            "telephone_number": "480-281-0180",
            "fax_number": "480-281-0165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2018-10-04",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "Y006162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1991735",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "847890",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #2676",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAFEWAY PHARMACY #2676",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.