Safeway Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

Y006220 Issued in AZ

Legal business name

SAFEWAY INC

Practice address

599 W 4TH St
Benson, AZ 85602-6501

Phone

(520) 586-7323

Fax

(520) 586-7449

NPI assigned

Jul 2, 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

Enrollments Manager

Phone

(208) 395-3954

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• SAFEWAY PHARMACY #1275 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX, AZ2 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.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Member of 3

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

• Genuardi'S Family Markets LP (GFM)

  • Community/Retail Pharmacy
  • King of Prussia, PA
  • NPI 1265659361

  Member Of

  NPD member
• Randalls Food & Drugs LP

  • Community/Retail Pharmacy
  • Georgetown, TX
  • NPI 1912419649

  Member Of

  NPD member
• Vons Companies Inc

  • Community/Retail Pharmacy
  • Rancho Santa Margarita, CA
  • NPI 1659300689

  Member Of

  NPD member

Locations

Practitioners 3

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

• Jessica Jensen Howe, PHARMD

  • Pharmacist
  • Vail, AZ
  • NPI 1902106669
  NPD (past)
• Lisa Dawn Kesling, RPH

  • Pharmacist
  • Benson, AZ
  • NPI 1427358878
  NPD (past)
• Douglas Eugene Miller, R.PH.

  • Pharmacist
  • Benson, AZ
  • NPI 1396906558
  NPD (past)

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1992734941",
    "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",
            "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": "599 W 4TH ST",
            "city": "BENSON",
            "state": "AZ",
            "postal_code": "856026501",
            "telephone_number": "520-586-7323",
            "fax_number": "520-586-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "GIANNAKOPOULOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ENROLLMENTS 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": "AZ",
            "license": "Y006220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1989468",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116443",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFEWAY PHARMACY #1275",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAFEWAY PHARMACY #1275",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• King Richard Randell, LPC, CADAC, ICADC
• Meena Rao, MD
• Joseph G Rizza, MD
• Glenn Gary Robertson, MD
• Pamela J Roller, RN
• San Pedro Family Care, PLC
• Rebecca Joy Satter, ARNP
• Philip Schneider, RN
• Lynn Marie Schroeder
• Amanda Sue Shorette, MD

• All providers in Benson, AZ
• Community/Retail Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 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.