Organization
GREAT ATLANTIC & PACIFIC TEA CO., INC.
Active
Other names
A & P Pharmacy # 761
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN D KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
19 AVE AT PORT IMPERIAL, WEST NEW YORK, NJ 07093
(201) 272-1171
(201) 867-1976
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
06687
NJ
333600000X
Pharmacy
Primary
06687
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0138382
—
NJ
01
—
06687
STATE LICENSE
NJ
01
—
3194278
NCPDP #
NJ
Enumeration date
04/13/2007
Last updated
10/11/2011
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