# GREAT ATLANTIC & PACIFIC TEA COMPANY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** A & P PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730104290
- **Authorized official:** SUSAN KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
- **Authorized official phone:** (201) 571-8326

## Contact information

- **Practice address:** 3113 ROUTE 22, PATTERSON, NY 12563-2342
- **Practice address phone:** (845) 878-2061
- **Practice address fax:** (845) 878-3013
- **Mailing address:** PO BOX 416369, BOSTON, MA 02241-6369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 023552 | NY | — |
| 333600000X | Pharmacy | 023552 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/13/2006
- **Last updated:** 10/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01818717 | — | NY |
| 01 | — | 018187170442 | MEDICAID DME | NY |
| 01 | — | 3334480 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |