Organization
PATHMARK STORES INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO
Authorized official
SUSAN D KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
407 VALLEY ST, SOUTH ORANGE, NJ 07079-2807
(973) 762-5044
(973) 378-3449
Mailing address
2 PARAGON DR, MONTVALE, NJ 07645-1718
(201) 573-9700
(201) 571-8335
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
RS2800325300
NJ
333600000X
Pharmacy
Primary
RS003807
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3102807
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4301005
—
NJ
Enumeration date
09/20/2006
Last updated
12/10/2008
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