Organization
SUPER FRESH FOOD MARKETS, INC.
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Other names
Super Fresh Pharmacy # 804
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Authorized official
MS. CAROL J. DINICOLANTONIO R.PH. MBA (SR. DIRECTOR, PHARMACY)
(201) 571-8334
Entity
Organization
Contact information
Practice address
616 E MAIN ST, LANSDALE, PA 19446-2964
(215) 855-5606
(215) 855-6097
Mailing address
616 E MAIN ST, LANSDALE, PA 19446-2964
(215) 855-5606
(215) 855-6097
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PP481110
PA
333600000X
Pharmacy
Primary
PP481110
PA
3336C0003X
Community/Retail Pharmacy
PP481110
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007725100056
—
PA
01
—
3987572
NCPDP #
PA
01
—
PP481110
STATE LICENSE
PA
Enumeration date
04/16/2007
Last updated
11/14/2007
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