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
3105 E MAIN ST, MOHEGAN LAKE, NY 10547-1521
(914) 526-0240
(914) 526-0244
Mailing address
PO BOX 416369, BOSTON, MA 02241-6369
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
023501
NY
333600000X
Pharmacy
Primary
023501
NY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01815627
—
NY
01
—
018156270442
MEDICAID DME
NY
01
—
3332741
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/13/2006
Last updated
10/06/2011
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