Provider Demographics
NPI:1487103875
Name:KING SOOPERS
Entity type:Organization
Organization Name:KING SOOPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:AWNI
Authorized Official - Last Name:SAFADI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-207-4089
Mailing Address - Street 1:5537 LEWIS CT
Mailing Address - Street 2:UNIT 203
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-4960
Mailing Address - Country:US
Mailing Address - Phone:313-207-4089
Mailing Address - Fax:
Practice Address - Street 1:5050 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-6361
Practice Address - Country:US
Practice Address - Phone:303-798-2521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy