Organization
FOOD BASICS INC
Active
Parent organization
GREAT ATLANTIC & PACIFIC TEA CO., INC.
Other names
DRUG BASICS PHARMACY #512
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT ATLANTIC & PACIFIC TEA CO., INC.
Authorized official
SUSAN KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
1417 KENNEDY BLVD # 27, NORTH BERGEN, NJ 07047-6307
(201) 864-5617
(201) 864-5623
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
(201) 864-5617
(201) 864-5623
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
06238
NJ
333600000X
Pharmacy
Primary
06238
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008087
—
NJ
01
—
0008095
MEDICAID DME
NJ
01
—
3135058
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
10/11/2011
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