Organization
GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Active
Other names
A & P PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
125 FRANKLIN TURNPIKE, MAHWAH, NJ 07430
(201) 512-9332
(201) 512-0149
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
05120
NJ
333600000X
Pharmacy
Primary
05120
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3136442
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
6511406
—
NJ
01
—
6511414
MEDICAID DME
NJ
Enumeration date
07/13/2006
Last updated
10/10/2011
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