# PATHMARK STORES INC

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

## Provider details

- **NPI number:** 1962509737
- **Legal business name:** GREAT ATLANTIC & PACIFIC TEA CO., INC, THE.
- **Authorized official:** SUSAN D KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
- **Authorized official phone:** (201) 571-8326

## Contact information

- **Practice address:** 5145 NESCONSET HWY, PORT JEFFERSON STATION, NY 11776-2047
- **Practice address phone:** (631) 331-2210
- **Practice address fax:** (631) 473-3291
- **Mailing address:** PO BOX 416369, BOSTON, MA 02241-6369
- **Mailing address phone:** (201) 571-4568
- **Mailing address fax:** (201) 571-8335

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 016040 | NY | — |
| 333600000X | Pharmacy | 016040 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/16/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00490111 | — | NY |
| 01 | — | 3364229 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |