Organization
WALDBAUM INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC
Other names
A AND P SUPERFOODMART PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO., INC
Authorized official
SUSAN KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
1700 PARK AVE, BRIDGEPORT, CT 06604-2520
(203) 368-2502
(203) 368-2506
Mailing address
1700 PARK AVE, BRIDGEPORT, CT 06604-2520
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
01655
CT
333600000X
Pharmacy
Primary
01655
CT
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0717504
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
11/26/2007
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