Organization
PATHMARK STORES INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA COMPANY, INC.
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA COMPANY, INC.
Authorized official
SUSAN D KIJOWSKI (REGULATORY COMPLIANCE SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
5100 WELLINGTON AVE, VENTNOR CITY, NJ 08406-1445
(609) 823-5875
(609) 823-6813
Mailing address
2 PARAGON DRIVE, MONTVALE, NJ 07645-1718
(201) 571-8326
(201) 571-8335
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
28RS00614200
NJ
333600000X
Pharmacy
Primary
28RS00614200
NJ
333600000X
Pharmacy
RS0006142
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3144502
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
8848301
—
NJ
Enumeration date
09/20/2006
Last updated
11/24/2010
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