Organization
PATHMARK STORES INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO INC
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO INC
Authorized official
SUSAN D KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
1757 CENTRAL PARK AVE, YONKERS, NY 10710-2828
(914) 961-2355
(914) 779-4071
Mailing address
2 PARAGON DR, MONTVALE, NJ 07645-1718
(201) 573-9700
(201) 571-8335
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
016026
NY
333600000X
Pharmacy
Primary
016026
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00502727
—
NY
01
—
3364178
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/20/2006
Last updated
10/08/2012
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