# PATHMARK STORES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PATHMARK PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053418814
- **Authorized official:** MINDI NORELLI (ADMIN)
- **Authorized official phone:** (732) 499-3313

## Contact information

- **Practice address:** 2660 HYLAN BLVD, STATEN ISLAND, NY 10306-4355
- **Practice address phone:** (718) 979-1005
- **Practice address fax:** (718) 980-5512
- **Mailing address:** 200 MILIK ST, M115, CARTERET, NJ 07008-1102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 014471 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 07/19/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00264833 | — | NY |
| 01 | — | 3314173 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |