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ALBERTSONS PHARMACY #3204
NPI 1346605185
Pharmacy - Community/Retail Pharmacy in Lake Havasu City, AZ

Active since December 21, 2015CLIA 03D2111176 · Waiver
1980 MCCULLOCH BLVD N, LAKE HAVASU CITY, AZ 86403(928) 854-8281(928) 453-3969 Get Directions Write a Review

NPPES record last updated: April 3, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 3, 2020, Nov 2, 2018, Jul 19, 2018 and 5 more (8 updates tracked since 2015).

About Albertsons Pharmacy #3204 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALBERTSONS PHARMACY #3204 (NPI 1346605185) is a healthcare organization registered as a community/retail pharmacy in Lake Havasu City, Arizona and active in the NPI registry since December 2015. The organization holds a CLIA Waiver certificate valid through March 30, 2028 and lists Kathy Giannakopoulos, Enrollment Manager, as its authorized official.

NPPES Registry Identity

NPI1346605185
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameALBERTSONS LLC
Location Address1980 MCCULLOCH BLVD NLake Havasu City, AZ 86403-0969
Mailing Address250 E Parkcenter BlvdBoise, ID 83706-3940
Phone(928) 854-8281
Fax(928) 453-3969
Organization SubpartNo
Authorized OfficialKathy GiannakopoulosEnrollment Manager · (208) 395-3954
Enumeration DateDecember 21, 2015
Last NPPES UpdateApril 3, 20208 updates tracked since enumeration
NPPES CertifiedApril 3, 2020
✔ NPI 1346605185 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in AZ · Y006761
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacyTaxonomy 333600000X
1980 MCCULLOCH BLVD N, Lake Havasu City, AZ 86403
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Other Names 1

Doing Business AsAlbertsons Pharmacy #3204

Other Identifiers 2

Other2157266Pk
Medicaid126104AZ

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2111176

Albertsons Pharmacy #3204 · Lake Havasu City, AZ
Active · expires Mar 30, 2028
CLIA Number03D2111176
Laboratory TypePharmacy
Certificate Effective DateMarch 31, 2026
Certificate Expiration DateMarch 30, 2028
Laboratory DirectorPrerana Sevak
Laboratory Phone(928) 854-8281
Laboratory LocationAlbertsons Pharmacy #32041980 Mcculloch Blvd, Lake Havasu City, AZ 86403
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 11

Medicare supplier enrollment and the product categories Albertsons Pharmacy #3204 carries, from the Medicare DMEPOS supplier directory.

Albertsons Pharmacy #3204

DMEPOS supplier · Lake Havasu City, AZOperated by Albertsons LLC
⋮

Does not accept Medicare assignment

Albertsons Pharmacy #3204 has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20621717
Medicare Participant SinceJanuary 1, 2001
Supplier Location1980 Mcculloch BlvdLake Havasu City, AZ 86403
Phone(928) 854-8281
Supplier Specialties
Pharmacy Grocery Store

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERTO AGUAYO PHARMD
Pharmacist
1980 MCCULLOCH BLVD N
LAKE HAVASU CITY, AZ 86403
Mohave County (928) 854-8281
1918 WINTER STREET OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
1980 MCCULLOCH BLVD N
LAKE HAVASU CITY, AZ 86403
Mohave County (928) 854-8281
DR. EZEKIEL KEERENG KESITILWE PHARMD
Pharmacy
1980 MCCULLOCH BLVD N
LAKE HAVASU CITY, AZ 86403
Mohave County (928) 854-8281

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Albertsons LLC's NPI number?

The NPI number for Albertsons LLC is 1346605185. It was assigned to this organization in the NPPES registry on December 21, 2015. The provider is doing business as Albertsons Pharmacy #3204.

Where is Albertsons LLC located?

Albertsons LLC is located at 1980 Mcculloch Blvd N, Lake Havasu City, AZ 86403. The listed phone number is (928) 854-8281.

What is Albertsons LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Albertsons LLC accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Albertsons Pharmacy #3204 does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Albertsons LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2111176) is associated with this NPI, valid through March 30, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Albertsons LLC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Arizona Complete Health and Ambetter from Arkansas Health & Wellness and 44 other insurers list Albertsons LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Albertsons LLC was last updated on April 3, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.