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Contact Information

ALBERTSONS LLC
1900 E SE LOOP 323
TYLER, TX75701-8337
 Phone: 903-597-8081
 Fax: 903-597-6296
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for ALBERTSONS LLC

NPI # 1063459527
LBN Legal business name ALBERTSONS LLC
Authorized official DAN JOHNSON - (MANAGER MANAGED HEALTHCARE)
Entity Organization
Organization subpart 1 No
Enumeration date 06/01/2006
Last updated 12/03/2010 - About 16 years ago
Identifiers
TX License # 13081
TX Medicaid 462975
Other 4578095 NCPDP PROVIDER IDENTIFICATION NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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