Provider Demographics
NPI:1962711770
Name:ALBERTSONS LLC
Entity type:Organization
Organization Name:ALBERTSONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF-PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PONNADA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-314-3271
Mailing Address - Street 1:808 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-2418
Mailing Address - Country:US
Mailing Address - Phone:575-887-5085
Mailing Address - Fax:
Practice Address - Street 1:808 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-2418
Practice Address - Country:US
Practice Address - Phone:575-887-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007444333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy