SAFEWAY PHARMACY #3011
NPI 1962448571
Pharmacy - Community/Retail Pharmacy in Petaluma, CA

Active since June 21, 2006CLIA 05D2059173 · Waiver
389 S MCDOWELL BLVD, PETALUMA, CA 94954(707) 766-9477(707) 762-1159 Get Directions Write a Review

NPPES record last updated: October 8, 2018. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Oct 8, 2018, Jul 19, 2018, Dec 21, 2016 (3 updates tracked since 2016).

About Safeway Pharmacy #3011 NPPES

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

SAFEWAY PHARMACY #3011 (NPI 1962448571) is a healthcare organization registered as a community/retail pharmacy in Petaluma, California and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through May 19, 2027 and lists Tiffany Eliopulos, Assistant Manager, Enrollments, as its authorized official.

NPPES Registry Identity

NPI1962448571
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSAFEWAY INC
Location Address389 S MCDOWELL BLVDPetaluma, CA 94954-3507
Mailing Address250 E Parkcenter Blvd, Mailstop Sec2-bBoise, ID 83712-3940 · (208) 395-6200 · Fax (623) 336-6896
Fax(707) 762-1159
Organization SubpartNo
Authorized OfficialTiffany EliopulosAssistant Manager, Enrollments · (208) 395-3906
Enumeration DateJune 21, 2006
Last NPPES UpdateOctober 8, 20183 updates tracked since enumeration
NPI 1962448571 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License Licensed in CA · PHY52352
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
389 S MCDOWELL BLVD, Petaluma, CA 94954

Other Names 1

Doing Business AsSafeway Pharmacy #3011

Other Identifiers 2

Medicaid1962448571CA
Other2075309Pk

Accepted 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 05D2059173

Safeway Pharmacy #3011 · Petaluma, CA
Active · expires May 19, 2027
CLIA Number05D2059173
Laboratory TypePharmacy
Certificate Effective DateMay 20, 2025
Certificate Expiration DateMay 19, 2027
Laboratory DirectorGunner Olsen
Laboratory Phone(707) 766-9477
Laboratory LocationSafeway Pharmacy #3011389 S Mcdowell Blvd, Petaluma, CA 94954
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

The provider carries the following medical supplies product categories:

PTAN
20465579
Accepts Medicare Assignment
NO
Specialities List
Pharmacy, Grocery Store.
Competitive Bidding
NO

Supplies List

  • 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
  • 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
  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
  • Orthoses: Off-The-Shelf - Met pads, Heel pads, Heel spur pads
  • Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
  • Urological Supplies - Catheters, Urinary collection devices
  • Surgical Dressings - Gauze, Elastic bandages, Adhesive tape
  • Diabetic Shoes and Inserts - Shoes, Socks, Insoles

Other Providers at the Same Location NPPES 2

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

Pharmacist
389 S MCDOWELL BLVD
PETALUMA, CA 94954
Pharmacist
389 S MCDOWELL BLVD
PETALUMA, CA 94954

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1962448571, enumerated as an "organization" on June 21, 2006.

The provider is located at 389 S MCDOWELL BLVD PETALUMA, CA 94954 and the phone number is (707) 766-9477.

Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.

The provider might be accepting Accepts: Alliant Health Plans, Inc., Ambetter from Arizona. Please consult your insurance carrier or call the provider to verify.