Provider Demographics
NPI:1841670742
Name:SAFEWAY PHARMACY
Entity type:Organization
Organization Name:SAFEWAY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:925-519-8120
Mailing Address - Street 1:2980 E CAPITOL EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4246
Mailing Address - Country:US
Mailing Address - Phone:408-274-5939
Mailing Address - Fax:408-274-5954
Practice Address - Street 1:2980 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4246
Practice Address - Country:US
Practice Address - Phone:408-274-5939
Practice Address - Fax:408-274-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty