Organization
PATHMARK STORES INC
Active
Parent organization
THE GREAT ATLANTIC & PACIFIC TEA COMPANY
Other names
PATHMARK PHARMACY #580
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE GREAT ATLANTIC & PACIFIC TEA COMPANY
Authorized official
SUSAN D KIJOWSKI (MANAGER, REGULATORY COMPLIANCE)
(201) 571-8326
Entity
Organization
Contact information
Practice address
1600 SAINT GEORGES AVE, AVENEL, NJ 07001-1044
(732) 499-7904
(732) 943-1479
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
(201) 571-8326
(201) 571-8335
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
RS28002936
NJ
333600000X
Pharmacy
Primary
28RS00293600
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3122330
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4326300
—
NJ
Enumeration date
09/20/2006
Last updated
10/11/2013
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