Organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Active
Other names
SUPER FRESH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
18578 COASTAL HWY, REHOBOTH BEACH, DE 19971-6154
(302) 644-7530
(302) 644-7523
Mailing address
2 PARAGON DR, MONTVALE, NJ 07645-1718
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
A30000667
DE
333600000X
Pharmacy
Primary
A30000667
DE
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000922407
—
DE
01
—
0803519
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
09/09/2013
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