# PATHMARK STORES INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THE GREAT ATLANTIC & PACIFIC TEA CO INC
- **Other names:** PATHMARK PHARMACY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1164529921
- **Legal business name:** THE GREAT ATLANTIC & PACIFIC TEA CO INC
- **Authorized official:** SUSAN D KIJOWSKI (PHARMACY SPECIALIST)
- **Authorized official phone:** (201) 571-8326

## Contact information

- **Practice address:** 13440 SPRINGFIELD BLVD, JAMAICA, NY 11413-1459
- **Practice address phone:** (718) 525-2422
- **Practice address fax:** (718) 525-2180
- **Mailing address:** 2 PARAGON DR, MONTVALE, NJ 07645-1718
- **Mailing address phone:** (201) 573-9700
- **Mailing address fax:** (201) 571-8335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 024533 | NY | — |
| 333600000X | Pharmacy | 024533 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 03/25/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 02042762 | — | NY |
| 01 | — | 3310478 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |