Organization
PATHMARK STORES INC
Active
Other names
PATHMARK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MINDI NORELLI (ADMIN)
(732) 499-3313
Entity
Organization
Contact information
Practice address
2660 HYLAN BLVD, STATEN ISLAND, NY 10306-4355
(718) 979-1005
(718) 980-5512
Mailing address
200 MILIK ST, M115, CARTERET, NJ 07008-1102
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
014471
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00264833
—
NY
01
—
3314173
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/20/2006
Last updated
07/19/2007
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