# PATHMARK STORES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
- **Other names:** PATHMARK PHARMACY \# 171
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1861623407
- **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:** 2660 HYLAN BLVD, STATEN ISLAND, NY 10306-4355
- **Practice address phone:** (718) 668-2972
- **Practice address fax:** (718) 668-2974
- **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 | 029643 | NY | — |
| 333600000X | Pharmacy | 029643 | NY | Yes |

## Other

- **Enumeration date:** 07/30/2009
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 029643 | STATE LICENSE | NY |