Organization
GREAT ATLANTIC & PACIFIC TEA CO., INC.
Active
Other names
A&P Pharmacy # 664
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN D KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
199 KINDERKAMACK RD, PARK RIDGE, NJ 07656-1335
(201) 391-3232
(201) 930-9672
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
06692
NJ
333600000X
Pharmacy
Primary
06692
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3194204
NCPDP #
NJ
05
—
8186804
—
NJ
01
—
8186812
MEDICAID DME
NJ
Enumeration date
03/21/2007
Last updated
10/10/2011
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