Organization
SUPER FRESH FOOD MARKETS INC
Active
Parent organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Other names
SUPER FRESH PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Authorized official
SUSAN KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
800 WEST AVE, OCEAN CITY, NJ 08226-3610
(609) 814-9791
(609) 814-9792
Mailing address
800 WEST AVE, OCEAN CITY, NJ 08226-3610
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
05807
NJ
333600000X
Pharmacy
Primary
05807
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3141900
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
8194009
MEDICAID DME
NJ
05
—
8194009
—
NJ
Enumeration date
07/13/2006
Last updated
11/18/2007
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