Provider Demographics
NPI:1811331762
Name:SAFEWAY PHARMACY
Entity type:Organization
Organization Name:SAFEWAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-762-1258
Mailing Address - Street 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3832
Mailing Address - Country:US
Mailing Address - Phone:308-762-1258
Mailing Address - Fax:308-762-2126
Practice Address - Street 1:4246 450TH RD
Practice Address - Street 2:
Practice Address - City:HAY SPRINGS
Practice Address - State:NE
Practice Address - Zip Code:69347-4236
Practice Address - Country:US
Practice Address - Phone:308-232-4576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEWAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3336C0003X305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service