Organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Active
Other names
LIVE BETTER PHARMACY # 441
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN D KIJOWSKI BS (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
216 OLD TAPPAN ROAD, OLD TAPPAN, NJ 07675
(201) 391-0639
(201) 391-1845
Mailing address
216 OLD TAPPAN ROAD, OLD TAPPAN, NJ 07675
(201) 391-0639
(201) 391-1845
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
06711
NJ
333600000X
Pharmacy
Primary
06711
NJ
3336M0002X
Mail Order Pharmacy
RS00671100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3194470
NCPDP #
NJ
01
—
D09109200
NJ STATE CDS LICENSE
NJ
01
—
RS00671100
NJ STATE PHARMACY LICENSE
NJ
Enumeration date
07/10/2007
Last updated
03/23/2009
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