Organization
GREAT ATLANTIC & PACIFIC TEA COMPANY INC
Active
Other names
A & P PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
3113 ROUTE 22, PATTERSON, NY 12563-2342
(845) 878-2061
(845) 878-3013
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
023552
NY
333600000X
Pharmacy
Primary
023552
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01818717
—
NY
01
—
018187170442
MEDICAID DME
NY
01
—
3334480
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
10/10/2011
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