Organization
SUPER FRESH FOOD MARKETS INC
Active
Parent organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Authorized official
SUSAN KIJOWSKI (REGULATORY COMPLIANCE SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
2101-41 COTTMAN AVE, PHILADELPHIA, PA 19149-1122
(215) 725-3582
(215) 725-3524
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
PP415281L
PA
333600000X
Pharmacy
Primary
PP415281L
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007725100050
—
PA
01
—
3972836
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
04/14/2011
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