Basic Information
| Provider Information | |||||||||
| NPI: | 1346850427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARR-GOTTSTEIN FOODS CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 E PARKCENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837063940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083956200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1340 GAMBELL ST | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995014630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073390260 | ||||||||
| FaxNumber: | 9073390219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2020 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | GIANNAKOPOULOS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ENROLLMENTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2083953954 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | Y | Suppliers | Pharmacy |
No ID Information.