1619915071 NPI number — ALBERTSONS LLC

Table of content: (NPI 1619915071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619915071 NPI number — ALBERTSONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERTSONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAVON PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619915071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 CULLERTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60131-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 PRECINCT LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76053-3866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-284-5176
Provider Business Practice Location Address Fax Number:
817-284-2646
Provider Enumeration Date:
06/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHREINER
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER PLAN IMPLEMENTATION
Authorized Official Telephone Number:
847-916-4711

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 14857 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 463394 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4584733 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".