Organization
SUPER FRESH FOOD MARKETS, INC.
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Other names
Super Fresh Pharmacy # 982
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Authorized official
MRS. SUSAN D KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
7162 RIDGE AVE, PHILADELPHIA, PA 19128-3250
(215) 508-7782
(215) 508-7785
Mailing address
7162 RIDGE AVE, PHILADELPHIA, PA 19128-3250
(215) 508-7782
(215) 508-7785
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PP481751
PA
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3988877
NCPDP #
PA
01
—
8970982
GROUP, DIV., STORE #
PA
Enumeration date
08/08/2007
Last updated
11/09/2007
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