Provider Demographics
NPI:1760860803
Name:SAFEWAY INC
Entity type:Organization
Organization Name:SAFEWAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, MANAGED CARE REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-467-2838
Mailing Address - Street 1:5918 STONERIDGE MALL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3229
Mailing Address - Country:US
Mailing Address - Phone:925-467-2838
Mailing Address - Fax:925-467-2802
Practice Address - Street 1:5918 STONERIDGE MALL RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3229
Practice Address - Country:US
Practice Address - Phone:925-467-2838
Practice Address - Fax:925-467-2802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AB ACQUISITION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPHC015Medicare PIN
TXP00229889Medicare PIN