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Albertsons LLC

Organization Active NPI Community/Retail Pharmacy · Carson, CA

NPI 1972559995 · NPPES record last updated Apr 6, 2020

Key facts

NPI
1972559995
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
PHY51325 (CA)
Legal business name
ALBERTSONS LLC
Practice address
200 E Sepulveda Blvd
Carson, CA 90745-6323
Phone
(310) 513-6800
Fax
(310) 513-6580
NPI assigned
May 25, 2006
Organization subpart
No

Authorized official

Name
Kathy Giannakopoulos
Title
Enrollment Manager
Phone
(208) 395-3954

Corporate family (same tax ID) 13

Organizations that report the same tax identification number in the National Provider Directory.

Member of 7

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130723000171 CA DME Supplier - Pharmacy
DME Supplier - Grocery Store		 8729983515 Practice locations: Carson, CA

National Provider Directory

Tax ID family
Albertsons 851 (386 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY51325 CA Yes

Addresses

Primary practice location

200 E Sepulveda Blvd
Carson, CA 90745-6323

Mailing address

250 E Parkcenter Blvd
Boise, ID 83706-3940

Other identifiers

IdentifierTypeStateIssuer
1998801OtherPK
071PHA476180MedicaidCA
071PHA456890MedicaidCA

Other names

  • Sav-On Pharmacy #3859 Doing business as

Other providers in Carson, CA

All providers in Carson, CA · Community/Retail Pharmacy in California

Sources for this page

Verify at the official NPI Registry.