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Contact Information

ALBERTSONS LLC
330 E BENTON ST
POCATELLO, ID83201
 Phone: 208-233-0651
 Fax: 208-478-1731
 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 Number 1669428173
LBN Legal business name ALBERTSONS LLC
Authorized official KATHY GIANNAKOPOULOS - (ENROLLMENT MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/26/2006
Last updated 04/02/2020 - About 6 years ago
Identifiers
ID License # 21053RP
ID Medicaid 002256400
ID Medicaid 807495400
Other 2020588 PK
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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