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
709 S BROADWAY, PENNSVILLE, NJ 08070-9655
(856) 935-7732
(856) 935-4752
Mailing address
709 S BROADWAY, PENNSVILLE, NJ 08070-9655
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
04869
NJ
333600000X
Pharmacy
Primary
04869
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3135109
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
6118801
—
NJ
01
—
6118810
MEDICAID DME
NJ
Enumeration date
07/13/2006
Last updated
11/18/2007
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