Organization
PATHMARK STORES INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Other names
PATHMARK PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA CO., INC.
Authorized official
SUSAN D KIJOWSKI (REGULATORY COMPLIANCE SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
95-101 NEW BRUNSWICK AVE, PERTH AMBOY, NJ 08861-2294
(732) 826-0600
(732) 826-8516
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
28RS00120000
NJ
333600000X
Pharmacy
Primary
RS001200
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3102946
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4261101
—
NJ
Enumeration date
09/20/2006
Last updated
10/05/2010
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