# WALDBAUM INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
- **Other names:** WALDBAUMS PHARMACY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639194285
- **Legal business name:** THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
- **Authorized official:** SUSAN KIJOWSKI (PHARMACY SPECIALIST)
- **Authorized official phone:** (201) 571-8326

## Contact information

- **Practice address:** 890 WALT WHITMAN RD, MELVILLE, NY 11747-2214
- **Practice address phone:** (631) 385-0153
- **Practice address fax:** (631) 385-0168
- **Mailing address:** 890 WALT WHITMAN RD, MELVILLE, NY 11747-2214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 022233 | NY | — |
| 333600000X | Pharmacy | 022233 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/13/2006
- **Last updated:** 11/15/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01534490 | — | NY |
| 01 | — | 015344900442 | MEDICAID DME | NY |
| 01 | — | 3353555 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |