Organization
THE GREAT ATLANTIC AND PACIFIC TEA COMPANY INC
Active
Other names
SUPER FRESH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
1155 ANNAPOLIS RD, ODENTON, MD 21113-1633
(410) 674-2137
(410) 674-3845
Mailing address
1155 ANNAPOLIS RD, ODENTON, MD 21113-1633
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P02455
MD
333600000X
Pharmacy
Primary
P02455
MD
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124167
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
11/24/2007
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